Esophageal Cancer Clinical Presentation

Updated: Aug 05, 2019
  • Author: Muhammad Masab, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Presentation

History

Dysphagia, the most common presenting symptom of esophageal cancer, is initially experienced for solids but eventually progresses to include liquids. It usually occurs when esophageal lumen diameter is under 13 mm and indicates locally advanced disease. 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, occurring in more than 50% of people with esophageal carcinoma. It is caused by dysphagia and tumor-related anorexia. 

  • Bleeding - Patients may experience bleeding from the tumor leading to iron deficiency anemia. 

  • 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 (persistent cough and recurrent pneumonia) - These can be caused by aspiration of undigested food or by direct invasion of the tracheobronchial tree by the tumor (tracheobronchial fistula); the latter is also a sign of unresectabiliy. 

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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.

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