Esophageal cancer

Esophageal cancer - Chronic

 

Definition  

Malignant carcinoma of the esophageal lining, identified by histological type and tumor location as either adenocarcinoma or squamous cell carcinoma.

 

Medical History  

* Barrett's ulcer of esophagus

* Gastroesophageal reflux disease [Gastroesophageal reflux disease - Chronic]

* Obesity [Obesity - Chronic]

* Smoking

* Alcohol Abuse

* Achalasia

* Esophageal erosions

* Dietary history

* Head and neck cancer

* Family history of Barrett's ulcer of esophagus

* Family history of Esophageal cancer

* Family history of Gastroesophageal reflux disease

 

Findings  

* Cough when swallowing

* Hepatomegaly

* Anemia - Chronic

* Hoarse

* Dysphagia - Chronic

* Fatigue

* Heartburn

* Indigestion - Chronic

* Loss of appetite

* Painful swallowing

* Reflux

* Vomiting

* Weight decreased

 

Tests  

 

Esophageal cancer  

* Esophagogastroduodenoscopy: Endoscopy revealing extensive ulceration or tumor bulging into the esophageal lumen is suggestive of esophageal cancer .

 

Esophageal cancer  

* Barium swallow: Barium studies revealing polypoid, infiltrative, varicoid, or ulcerative lesions may suggest esophageal cancer .

 

Suspected anemia of chronic disease in patients with suspected or known esophageal cancer  

* Complete blood count

 

Suspected and known esophageal cancer  

* Metabolic function test: Patients with esophageal cancer may have an abnormal comprehensive metabolic panel secondary to complications of the disease.

 

Esophageal cancer  

* Computerized axial tomography: CT imaging of the chest and abdomen is recommended for all esophageal cancer patients as part of the presurgical staging workup, and to assess response to preoperative chemotherapy/radiation therapy .

 

Esophageal cancer  

* Endoscopic ultrasound of upper gastrointestinal tract: In the absence of M1 disease, endoscopic ultrasound is recommended as part of the presurgical staging workup for esophageal cancer .

 

Lymphadenopathy  

* Fine needle aspiration of lymph node: Fine needle aspiration biopsy may be used to assess lymphadenopathy when infection or metastatic cancer are strongly suspected.

 

Suspected lung cancer  

* Bronchoscopy: Bronchoscopic techniques are most useful in diagnosing centrally located tumors; further testing is recommended for nondiagnostic results .

 

Assessment of distant metastases  

* Positron emission tomography

 

Differential Diagnosis  

* Achalasia

* Esophageal stricture

* Scleroderma - Chronic

* CREST syndrome

* Diffuse spasm of esophagus

* Esophagitis

* Terminal esophageal web

* Squamous cell carcinoma of esophagus

* Adenocarcinoma of esophagus

* Plummer-Vinson syndrome

* Megaesophagus in Chagas' disease

* Benign neoplasm of esophagus

 

Treatment  

 

Drug Therapy  

 

Esophageal cancer  

 

FLUOROURACIL

 

FLUOROURACIL

 

 

CISPLATIN

 

MITOMYCIN

 

BLEOMYCIN SULFATE  

 

METHOTREXATE SODIUM  

 

DOXORUBICIN HYDROCHLORIDE  

 

MITOGUAZONE  

 

VINDESINE SULFATE  

 

PACLITAXEL

 

DOCETAXEL

 

VINORELBINE TARTRATE  

 

OXALIPLATIN

 

LOBAPLATIN  

 

IRINOTECAN HYDROCHLORIDE  

 

NEDAPLATIN

 

GEFITINIB

 

Procedural Therapy  

 

Esophageal cancer  

* Radiation therapy care: Radiation therapy (RT) alone is recommended only for palliation, or for patients who are medically unable to receive chemotherapy .

 

Esophageal cancer  

* Esophagectomy: Esophageal resection should be considered for localized resectable thoracic esophageal cancer, or gastroesophageal junction cancer .

Metastatic esophageal cancer  

* Palliative care - Acute: Palliative care aimed at symptom control is the only appropriate treatment for metastatic esophageal carcinoma .

 

Non-Procedural Therapy  

 

Esophageal cancer  

* Lifestyle measures

 

Esophageal cancer  

* Lifestyle measures