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ESOPHAGEAL CANCER
  • Relative 5 yr. survival rate is low in this condition because it is usually detected at an advanced stage
  • Predisposing factors are as follows:
    • Plummer-Vinson syndrome
    • caustic damage to the esophagus in the past
    • other head and neck tumors
    • tylosis, which is a hereditary condition characterized by thickening of the palms and soles
    • infections e.g. human papilloma virus and H. pylori infections
    • chronic reflux esophagitis leading to Barrett's esophagus


 SIGNS AND SYMPTOMS

  • Difficulty with swallowing
  • Significant weight loss
  • Heartburn
  • Painful swallowing
  • Coughing up or vomiting blood
  • Shortness of breath if the cancer has eroded into the trachea
  • Anemia
  • Recurrent laryngeal nerve involvement


 DIAGNOSIS AND STAGING

  • Chest x-ray
  • Barium swallow
  • Upper endoscopy to obtain tissue for histologic diagnosis
  • CAT scan of the chest and abdomen to rule out liver / adrenal involvement
  • Complete blood count with differential
  • Electrolytes
  • Bone scan
  • MRI scan of the esophagus
  • Bronchoscopy
  • Neurological evaluation


 TREATMENT

  • Surgical resection gives the best chance for cure
  • In advanced , unresectable cases , the following are possible treatment alternatives depending on the performance status of the individual:
    • Combined chemotherapy and radiation therapy. Common agents that are being used include 5FU and cisplatin and 5FU/Mitomycin combinations.
    • Evaluation for surgical resectability after a combination of chemotherapy and radiation therapy.
    • Radiation therapy alone is not sufficient but could be used if the patient cannot tolerate chemotherapy
    • Neoadjuvant chemotherapy is not advised.
    • Other important treatment modalities include total parenteral nutrition, feeding tube placement, intravenous antibiotics in cases where complications of local spread to adjacent structures are present e.g. pneumonia
    • In a situation where the disease becomes progressive, a living will should be discussed with the patient or the family (if the patient cannot make a decision).
    • Adequate pain control is essentia