Cancer of the Esophagus

1. Cause

1.1. Smoking tobacco

1.2. Alcohol consumption

1.3. Low vegetable intake

1.4. Low fruit intake

1.5. Not genetic

2. Risk Factors

2.1. Chronic severe reflux/esophagitis

2.2. Smoking

2.3. Heavy alcohol usage

2.4. Hiatal hernia

2.5. Advanced age over 50

2.6. Male 2 -3x more than females

2.7. Caucasian

2.8. Obesity intra-abdominal body fat

2.9. Heartburn

3. Diagnostic Tests

3.1. EGD with biopsy

3.2. CBC

3.3. CMP

3.4. Barium swallow

3.5. CT scan

3.6. MRI

3.7. PET scan

3.8. Bronchoscopy

3.9. HER2 Protein

3.10. Liver enzymes

4. Treatment

4.1. Depends on stage

4.2. Esophagectomy

4.3. Endoscopic therapy

4.4. Radiation

4.5. Chemotherapy

4.6. Targeted therapy

5. Pathophysiology of Adenocarcinoma

5.1. Acid from gastroesophageal reflux and bile damages squamous cells in esophagus

5.2. Squamous epithelium replaced with columnar epithelium = Barrett's esophagus

5.3. Barrett's esophagus - hyperplasia leading to dysplasia

5.4. Low grade dysplasia to carcinoma insitu

5.5. Carcinoma insitu to adenocarcinoma

6. Common Findings/Signs & Symptoms

6.1. Heartburn/pressure/indigestion

6.2. Dysphagia (most common) solid foods

6.3. Weight loss due to dysphagia

6.4. Epigastric or retrosternal chest pain

6.5. Persistent cough

6.6. Bleeding leading to iron deficiency

6.7. Bone pain with metastatic disease

6.8. Hoarseness if larynx involved

6.9. Hiccups

6.10. Vomiting

7. Inflammatory Influence

7.1. Acid from stomach and bile move up into esophagus creating inflammation of the esophageal lining damaging esophageal lining

8. Types of cancer

8.1. Adenocarcinoma

8.2. Squamous cell carcinoma

9. Pathophysiology of Squamous Cell Carcinoma

9.1. Dysplastic epithelium = white patches

9.2. Patches grow into mass

9.3. Mass obstructs esophageal lumen