RISK FACTORS: Smoking, Excess alcohol consumption, Head and neck tumors, Nitrates in foods, Lye stricture, Achalasia, Tylosis, Plummer-Vinson syndrome, Coexisting primary oro-pharyngeal carcinoma, Barrett’s metaplasia, Gastroesophageal reflux
GENERAL MEASURES :
• Palliative therapeutic options include: surgery, radiotherapy, chemotherapy, laser photocoagulation,
photodynamic therapy, dilation, placement of endoluminal prosthesis (stent) or combination of these methods.
The specific choice will depend on the extent of the tumor and symptoms and the individual patient’s state
of health.
SURGICAL MEASURES :
• Majority of tumors are not resectable for cure at time of presentation
• Important to stage the lesion before determining treatment plan
• Strictures may be dilated for temporary relief
• Prior to surgery - average patient requires nutritional and pulmonary preparation, e.g., feeding tube with
formula diet and respiratory therapy
• Endoluminal prosthesis may be attempted for patients who have failed other methods of palliation
DIET :
• Soft to liquid
• High calorie supplements (usually liquid)
DRUG(S) OF CHOICE :
• Chemotherapy in selected patients
• Analgesics
• Antacids, H2 receptor antagonist, or proton pump inhibitors when gastroesophageal reflux symptoms co-exist
• Metoclopramide if gastric emptying problems coexist (frequently paraneoplastic)
ALTERNATIVE DRUGS :
• Cisapride if gastric emptying problems coexist (frequently paraneoplastic)
PATIENT MONITORING : Individualized to follow results of preoperative and postoperative treatment
PREVENTION/AVOIDANCE :
• Avoid tobacco, excess alcohol, corrosive chemicals
• Endoscopic surveillance of those at high risk (Barrett’s, esophagus, head and neck cancer)
POSSIBLE COMPLICATIONS :
• Metastases to anterior jugular, supraclavicular, subdiaphragmatic lymph nodes, liver, lungs
• Complications from surgical procedures (anastomotic leak or stricture, fi stula formation, empyema, malnutrition)
• Radiation can cause esophageal perforation, stricture, fistula, esophagitis, pneumonitis, myelitis, and pulmonary fibrosis
• Toxicities of chemotherapy - nausea, vomiting, hair loss, gastroenteritis, hematopoietic and immune
depression
• Tubes can become blocked or dislodged
• Aspiration from esophageal obstruction
EXPECTED COURSE/PROGNOSIS :
• Overall 5-year survival 5%; in squamous cell carcinoma with uninvolved lymph nodes 15-20%
• Death rate following resection or bypass is 10-15%