Esophageal cancer

Difficult to swallow

Step 1: View clinicals

A 54-year-old Caucasian man presents with progressive dysphagia for 3 months. This is only to solids, and is associated with a sensation of food getting stuck in the middle of his chest. He has also lost 10 pounds of weight over the past three months. He does not take any medications presently, and specifically, has never taken medications for heartburn. However, further questioning reveals that he has experienced multiple episodes of regurgitant material coming up to his throat, especially at night, for several years now. His medical and family histories are otherwise unremarkable. He is an active smoker with a greater than 30 pack year smoking history and drinks alcohol socially.


Step 2: Order all relevant investigations

Barium Esophagogram

There is a focal area of luminal narrowing in the distal third of the esophagus.

Upper GI Endoscopy

An intraluminal ulcerating mass is found in the distal third of the esophagus. The stomach and duodenum appear normal. Histology of biopsies of the mass is in keeping with a grade 3 (poorly differentiated) esophageal adenocarcinoma. Subsequent endoscopic ultrasound (EUS) reveals that the tumor has infiltrated the adventitia of the esophagus.

CT Thorax + Abdomen

There is no evidence of solid tumor metastasis or lymphadenopathy in the thorax, abdomen, or pelvis.

H. pylori serology

H. pylori serology is negative


Step 3: Select appropriate management

Esophagectomy
Chemotherapy
Radiotherapy
Endoscopic dilatation and stenting


Score: ★★☆