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Esophageal Cancer Clinical Presentation

  • Author: Keith M Baldwin, DO; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
 
Updated: Sep 18, 2015
 

History and Physical Examination

History

Dysphagia, the most common presenting symptom of esophageal cancer, is initially experienced for solids but eventually progresses to include liquids. A complaint of dysphagia in an adult should always prompt an endoscopy to help rule out the presence of esophageal cancer. A barium swallow study is also indicated in these cases.

Other symptoms include the following:

  • Weight loss - This is the second most common symptom and occurs in more than 50% of people with esophageal carcinoma
  • Bleeding - Patients may experience bleeding from the tumor
  • Pain - Pain may be felt in the epigastric or retrosternal area; pain over bony structures indicates metastatic disease
  • Hoarseness - This is caused by invasion of the recurrent laryngeal nerve; it is a sign that the cancer has progressed beyond the point at which surgical resection remains possible
  • Persistent cough
  • Respiratory symptoms - These can be caused by aspiration of undigested food or by direct invasion of the tracheobronchial tree by the tumor; the latter is also a sign of unresectability

Physical examination

Physical examination findings in patients with esophageal cancer are typically normal, unless the cancer has metastasized to neck nodes or the liver. Lymphadenopathy in the laterocervical or supraclavicular area or the presence of hepatomegaly often indicates unresectable disease.

 
 
Contributor Information and Disclosures
Author

Keith M Baldwin, DO IMPH, Assistant Professor of Surgery, Boston University School of Medicine; Endocrine and Surgical Oncologist, Department of General Surgery, Roger Williams Cancer Center

Keith M Baldwin, DO is a member of the following medical societies: American College of Surgeons, Society of Surgical Oncology, American Association of Endocrine Surgeons, Americas Hepato-Pancreato-Biliary Association, Society of International Humanitarian Surgeons/Surgeons OverSeas (SOS)

Disclosure: Nothing to disclose.

Coauthor(s)

Marco G Patti, MD Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine

Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American Surgical Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, Western Surgical Association

Disclosure: Nothing to disclose.

N Joseph Espat, MD, MS, FACS Harold J Wanebo Professor of Surgery, Assistant Dean of Clinical Affairs, Boston University School of Medicine; Chairman, Department of Surgery, Director, Adele R Decof Cancer Center, Roger Williams Medical Center

N Joseph Espat, MD, MS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Clinical Oncology, Americas Hepato-Pancreato-Biliary Association, Association for Academic Surgery, Central Surgical Association, Chicago Medical Society, International Hepato-Pancreato-Biliary Association, Pancreas Club, Sigma Xi, Society for Leukocyte Biology, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Surgical Oncology, Society of University Surgeons, Southeastern Surgical Congress, Southern Medical Association, Surgical Infection Society

Disclosure: Nothing to disclose.

Fernando AM Herbella, MD, PhD TCBC, Affiliate Professor, Attending Surgeon in Gastrointestinal Surgery, Esophagus and Stomach Division, Department of Surgery, Federal University of Sao Paulo, Brazil; Private Practice; Medical Examiner, Sao Paulo's Medical Examiner's Office Headquarters, Brazil

Fernando AM Herbella, MD, PhD is a member of the following medical societies: Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Chief Editor

N Joseph Espat, MD, MS, FACS Harold J Wanebo Professor of Surgery, Assistant Dean of Clinical Affairs, Boston University School of Medicine; Chairman, Department of Surgery, Director, Adele R Decof Cancer Center, Roger Williams Medical Center

N Joseph Espat, MD, MS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Clinical Oncology, Americas Hepato-Pancreato-Biliary Association, Association for Academic Surgery, Central Surgical Association, Chicago Medical Society, International Hepato-Pancreato-Biliary Association, Pancreas Club, Sigma Xi, Society for Leukocyte Biology, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Surgical Oncology, Society of University Surgeons, Southeastern Surgical Congress, Southern Medical Association, Surgical Infection Society

Disclosure: Nothing to disclose.

Acknowledgements

Philip Schulman, MD Chief, Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center

Philip Schulman, MD, is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Endoscopy demonstrating intraluminal esophageal cancer.
Cascade of events that lead from gastroesophageal reflux disease to adenocarcinoma.
Barium swallow demonstrating stricture due to cancer.
Barium swallow demonstrating an endoluminal mass in the mid esophagus.
Chest CT scan showing invasion of the trachea by esophageal cancer.
Transhiatal esophagectomy in which (a) is the abdominal incision, (b) is the cervical incision, and (c) is the stomach stretching from abdomen to the neck.
Five-year survival for esophageal cancer based on TNM stage.
H and E, high power, showing junction of benign glands in the lower right, Barrett's columnar cell metaplasia with a large goblet cell containing blue mucin in the lower center and adenocarcinoma on the left.
Macroscopic image of a resection of the gastroesophageal junction. On the right is non-neoplastic esophagus, consisting of tan, smooth mucosa. On the left is the non-neoplastic rugal folds of the stomach. In the center of the picture is an ulcer with a yellow-green fibrinous exudate surrounded by irregular, heaped-up margins with almost a cobblestone appearance. The latter represents mucosal adenocarcinoma with probably some Barrett's metaplasia in the background.
H and E, high power, demonstrating invasive esophageal squamous cell carcinoma. This carcinoma does not form glands and instead shows features of squamous differentiation, including keratinization and intercellular bridges.
Macroscopic image of an esophageal resection. A polypoid squamous cell carcinoma is visible protruding from the esophageal mucosal surface (left center of specimen).
On this positron emission computed tomography (PET) scan, esophageal cancer is evident as a golden lesion in the chest.
Table 1. Staging Classification.
Stage IA T1 N0 M0
Stage IB T2 N0 M0
Stage IIA T3 N0 M0
Stage IIB T1,T2 N1 M0
Stage IIIA T4a N0 M0
  T3 N1 M0
  T1,T2 N2 M0
Stage IIIB T3 N2 M0
Stage IIIC T4a N1,N2 M0
  T4b Any N M0
  Any T N3 M0
Stage IV Any T Any N M1
Table 1. Staging Classification.
Stage IA T1 N0 M0
Stage IB T2 N0 M0
Stage IIA T3 N0 M0
Stage IIB T1,T2 N1 M0
Stage IIIA T4a N0 M0
  T3 N1 M0
  T1,T2 N2 M0
Stage IIIB T3 N2 M0
Stage IIIC T4a N1,N2 M0
  T4b Any N M0
  Any T N3 M0
Stage IV Any T Any N M1
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