Esophageal Cancer
Cancer of the esophagus, often presenting late with difficulty swallowing.
Overview
Esophageal cancer includes squamous cell carcinoma (upper/mid esophagus, associated with smoking/alcohol) and adenocarcinoma (lower esophagus, associated with GERD/Barrett's). Surgical resection offers the best chance of cure for locoregional disease.
Causes
- Squamous: Smoking, alcohol, hot beverages, nutritional deficiency
- Adenocarcinoma: GERD, Barrett's esophagus, obesity
- HPV infection (some squamous)
- Achalasia (long-standing)
- Caustic injury
Risk Factors
- Smoking and alcohol (synergistic)
- Chronic GERD
- Barrett's esophagus
- Obesity
- Male gender (3:1)
- Age over 55
- Low fruit/vegetable intake
- History of head/neck cancer
Symptoms
Diagnosis
- Upper GI endoscopy with biopsy
- CT chest/abdomen (staging)
- PET-CT (M staging)
- Endoscopic ultrasound (T and N staging)
- Bronchoscopy (for upper/mid tumors near airway)
- Laparoscopy/thoracoscopy (staging)
Treatment Options
Surgical Treatment
Esophagectomy is the mainstay of curative treatment. The approach (Ivor Lewis, McKeown three-stage, or transhiatal) depends on tumor location and surgeon expertise. Neoadjuvant chemoradiation (CROSS regimen) improves survival for locally advanced tumors. Minimally invasive esophagectomy (MIE) reduces complications.
Recovery
Esophagectomy: 8-14 days hospital stay. Small frequent meals for life. Jejunostomy feeding initially. Gradual diet progression over 3-4 weeks. Dumping syndrome management. Lifelong surveillance with endoscopy and CT.
Prevention
- Quit smoking and reduce alcohol
- Treat GERD aggressively
- Surveillance for Barrett's esophagus
- Maintain healthy weight
- High fruit/vegetable diet
- Endoscopic ablation for Barrett's with dysplasia
Frequently Asked Questions
Can esophageal cancer be caught early?
How will eating change after esophagectomy?
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