Diagnosis
H&P:
Risk factors.
Common Presentation: Patient with risk factors presents with dysphagia with or without unintentional weight loss. Dysphagia starts with solids first, then advances to liquids as the disease progresses.
Diagnostic studies
–Upper endoscopy with biopsy of suspicious lesions is the diagnostic study of choice.
-If cancer is confirmed, CT and PET scanning are helpful for staging.
–If distant metastasis found → Palliative therapy with brachytherapy or stents.
–If localized (no distant Mets) → Endoscopic Ultrasound (U/S).
—If the U/S shows lymphovascular invasion, do an FNA and then determine treatment option from results.
—If the U/S doesn’t show lymphovascular invasion, then small lesions (≤ 2 cm) that are limited to the mucosa or lamina propria can be resected. Others need FNA to determine treatment options.
-DDx & Etiology:
–Diagnostic and Treatment Algorithm (AAFP 2017)
Treatment
Treatment is based on stage.
Background: Adenocarcinoma is the most common esophageal cancer in developed nations.
Further Reading
Am Fam Physician 2017;95(1):22-28. Esophageal cancer.