- 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
- Painful swallowing
- Coughing up or vomiting blood
- Shortness of breath if the cancer has eroded into the trachea
- 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
- Bone scan
- MRI scan of the esophagus
- Neurological evaluation
- 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