Definition and Pathology
• Malignant tumors of the esophagus are more common than benign tumors.
• The most common benign tumor is leiomyoma and is frequently seen in the middle third of the esophagus.
• Malignant tumors of the esophagus are generally more common in men over 50 years of age.
The most common malignant tumor is squamous cell carcinoma. It is often located in the middle 1/3 esophagus.
Adenocancers usually originate from Barret's metaplasia and are therefore more common in the lower third of the esophagus.
Esophageal cancers are most common in the form that extends to the polypoid-lumen, and are most frequently located in the lower 1/3 esophagus in total.
Esophageal cancers cannot be distinguished radiographically or endoscopically.
Esophageal squamous cell cancer risk factors
• Advanced age (> 50)
• Male gender
• Black race
• Low socioeconomic status
• Alcohol and smoking
• Chronic achalasia
• Family history
• Mediastinal radiotherapy
• Hot drinks and caustic burns
• Plummer-Vinson syndrome
• Human papilloma virus
• Tylosis (palmar keratosis)
• Diet devoid of selenium, zinc, VitA
• Nitrites, pickled mushrooms, opium
Esophageal adenocarcinoma risk factors
• Male gender
• Obesity
• Chronic reflux
• Barret's esophagus
• Cigaret
• Bile reflux
Clinic
• Esophageal cancer should come to mind first in an elderly patient presenting with progressive dysphagia (the most common symptom) and weight loss.
• Barium X-ray is useful in diagnosis, but if there is high suspicion, direct endoscopy is performed.
• Definitive diagnosis is made by biopsy.
• Endoscopic ultrasonography is the most valuable method for local spread of the tumor (T stage) and regional lymph nodes (N stage).
• CT and PET /CT are used to detect distant metastases.
• Since the esophagus does not have a serosa, its tumors tend to metastasize early and most cases are metastatic at diagnosis.
Treatment
• In cases confined to the mucosa/submucosa, endoscopic resection can be performed
• Surgical treatment is performed in cases where the tumor is limited to the esophagus.
• Treatment of tumors with distant metastases is chemotherapy and palliative therapy.