Esophageal Cancer with Case

00:01 Let's move on to our next case.

00:03 We have a 76-year-old woman seen in clinic for difficulty swallowing foods for the past two months.

00:09 She has a history of GERD for which she has taken omeprazole for the past 12 years.

00:14 She has no other past medical history.

00:16 She is an on-going smoker and has a 25-pack-year smoking history.

00:21 Vitals are normal. Physical exam is unremarkable and labs are normal.

00:26 What is the most likely diagnosis? So she has dysphagia to solid foods which is concerning for a type of mechanical obstruction, she has a long-standing history of GERD, and she's a tobacco user.

00:40 So let's talk a bit about esophageal cancer.

00:45 This is the sixth leading cause of worldwide deaths related to cancer.

00:50 There are two types; you may have squamous carcinoma or SCC or adenocarcinoma.

00:56 In general, it has very poor prognosis.

00:59 Because diagnosis is often made in the late stage, patients tend to have five-year survival between 15 and 25% So here on the right you can see the diagram depicting what areas tend to form squamous cell carcinoma versus adenocarcinoma.

01:16 The upper part of the esophagus is prone to developing SCC while the lower part is prone to developing adenocarcinoma.

01:23 Patients may present with dysphagia to solids, weight loss, anorexia or lack of hunger, and anemia.

01:31 The diagnosis should be made with upper endoscopy along with biopsy.

01:36 After that, staging may often be done with a CT scan or PET imaging. In general, treatments, depends on the stage, but when it is resectable you may do surgery or you may offer neoadjuvant chemoradiation.

01:53 So there are many different risk factors for esophageal cancer. It depends on what type.

01:58 Here is a list -- a limited list for you to review. I will just point out that Barrett esophagus, because it's a premalignant condition, places people at risk for adenocarcinoma.

02:08 So now let's return to our case.

02:11 We have 76-year-old woman who has dysphagia to solid foods which is concerning for a mechanical obstruction, she also has a long-standing history of GERD and a tobacco user.

02:22 What is the best next step in diagnosis? So putting this all together, she has a high risk for esophageal adenocarcinoma.

02:31 The next step should upper endoscopy.

02:34 Thank you for your attention.