Snapshot A 62-year-old man presents to the physician with complaint of fatigue and weight loss. His wife noted that he has looked thinner in the past few months, at which point he weighed himself and noted that he had unintentionally lost 10 pounds in the past few months. He has also had increased difficulty swallowing his food with occasionally choking. He has a history of alcohol use disorder and has smoked 1 pack of cigarettes daily for the past 40 years. An upper endoscopy is performed and demonstrates the finding seen in the image. Introduction Overview malignancy affecting the esophagus most cases of esophageal malignant tumors are due to squamous cell carcinoma and adenocarcinoma Epidemiology incidence adenocarcinoma > squamous cell carcinoma in Western countries login to view 1 more bullet squamous cell carcinoma is the predominant type of esophageal cancer worldwide demographics most common > 50 years of age men > women location distal esophagus login to view 1 more bullet middle esophagus login to view 1 more bullet risk factors smoking login to view 1 more bullet alcohol consumption login to view 1 more bullet Barrett esophagus login to view 1 more bullet gastroesophageal reflux disease login to view 1 more bullet Plummer-Vinson syndrome login to view 1 more bullet Prognosis negative factors increased grade of tumor metastasis to other areas of the body Presentation History patients often complain of difficulty swallowing solids that progresses to difficulty swallowing liquids Symptoms progressive dysphagia unintentional weight loss bleeding epigastric or retrosternal pain hoarseness persistent cough Physical exam typically normal exam unless the cancer has metastasized cervical or supraclavicular lymphadenopathy (indicating metastasis) Studies Upper gastrointestinal endoscopy allows for direct visualization and biopsies if a tumor is present Histology squamous cell carcinoma keratinocyte-like cells with intercellular bridges or keratinization adenocarcinoma well or moderately differentiated intestinal-type mucosa cells with well-formed tubular or papillary structures Differential Gastroesophageal reflux disease (GERD) differentiating factor absence of malignancy on esophageal biopsy Treatment Medical chemoradiation indication login to view 1 more bullet systemic chemotherapy with palliative care indication login to view 2 more bullets Surgical endoscopic mucosal resection indication login to view 1 more bullet esophagectomy or esophagogastrectomy indication login to view 1 more bullet Complications Esophageal obstruction Metastasis distant metastasis typically to the liver, lungs, and adrenal glands