FOLLOW US

Tuesday, December 29, 2015

Esophageal Cancer

Esophageal Cancer

A 62-year-old man comes for evaluation of progressive “difficulty swallowing solids and, recently, semisolids” for 4 months. He has noticed a 20-lb weight loss. His past medical history is significant for reflux esophagitis for 15 years and a 40-pack-year smoking history. On the physical examination, a 1.5-cm, left supraclavicular lymph node is found. The remainder of the physical examination is unremarkable.

Pathogenesis. Esophageal cancer is linked to the synergistic, carcinogenic effect of alcohol and tobacco use for cases of squamous cell cancer in the proximal two-thirds of the esophagus. Adenocarcinoma is found in the distal third of the esophagus and is associated with long-stand- ing gastroesophageal reflux disease and Barrett esophagus. The rate of development of cancer from Barrett esophagus is between 0.4 and 0.8% per year. Squamous and adenocarcinoma are now of equal frequency.
Clinical Presentation. Esophageal cancer presents with progressive dysphagia first for solid food, then for liquids. Weight loss is prominent. Rarely, halitosis, regurgitation, and hoarseness occur. Hypercalcemia may arise, as it can with most cancers.
Diagnosis. Although a barium swallow can be done first, endoscopy is mandatory because this is a diagnosis that requires a tissue biopsy. CT scanning detects the degree of local spread, and bronchoscopy detects asymptomatic spread into the bronchi. Endoscopic ultrasound is performed for staging.
Treatment. The only truly effective therapy for esophageal carcinoma is surgical resection if the disease is sufficiently localized to the esophagus. Only 25% of patients are found to be oper- able. A total of 10 to 20% will die from the surgery. Five-year survival is between 5 and 20%. Chemotherapy with a 5-fluorouracil-based chemotherapy is combined with radiation to control locally metastatic disease.

1 comment:

  1. Been diagnosed with multiple sclerosis in 2015, and I was a woman of 50. They put me on Rebif which I took until 2017 and was switched to Copaxone. I had two relapses on Rebif, none so far on Copaxone. I do notice my balance was getting worse, and my memory, i had no choice to sick for other solution and I was introduce to multivitamincare .org which I purchase the MS herbal formula from the org, the herbal supplement has successfully get rid of my multiple sclerosis and reversed all symptoms after using the herbs as the Dr said , this is almost a miracle and do believe multivitamincare .org herbal cure will be recognize globally because am sure the world are yet to see their wonderful work.

    ReplyDelete