Esophageal cancer
1. Big picture
Esophageal cancer is a high-mortality upper gastrointestinal malignancy where surgery is only curative if the disease is localized, staged correctly, and the patient is fit for major surgery. The key surgical problem is that patients often present late with progressive dysphagia and weight loss, by which time the tumor may already have invaded deeply or metastasized.
For the oral exam, think in this order:
Progressive dysphagia → endoscopy + biopsy → staging CT/PET-CT/EUS → MDT decision
→ curative multimodal treatment if resectable
→ esophagectomy with lymphadenectomy if operable
→ palliation if metastatic/unresectable/unfit
The two main histological types are adenocarcinoma and squamous cell carcinoma. Adenocarcinoma usually arises in the distal esophagus/gastroesophageal junction, often from Barrett esophagus, while squamous cell carcinoma can occur throughout the esophagus and is strongly associated with smoking and alcohol. ([Cancer.gov][1])
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