Squamous Cell Carcinoma

The most common esophageal tumor is squamous cell carcinoma, which occurs predominantly in the middle and lower thirds of the esophagus. Predisposing conditions are nicotine and alcohol abuse, caustic injuries, achalasia, and the rare Plum-mer-Vinson syndrome (Table 3.7). The cardinal symptom is dy-sphagia, although even pronounced tumors may cause few if any complaints (Table 3.8).

Table 3.7 Risk patients and predisposing conditions for esophageal carcinoma

► Alcohol abuse

Nicotine abuse

► Caustic injury

► Barrett esophagus

► Plummer-Vinson syndrome

Scleroderma

► Palmar and plantar hyperkeratosis

Table 3.8 Symptoms of esophageal carcinoma

► Dysphagia

90 %

► Weight loss

50%

► Retrosternal pain

30%

► Regurgitation

< 20%

► Salivation

< 20%

► Fetor

< 20%

- Ulcerated carcinoma (second most common form)

- Deep ulcer with raised edges that show nodular thickening

- Diffusely infiltrating carcinoma (less common)

- Often shows circumferential growth, occasional sub-mucous growth

- Indurated wall, eccentric luminal narrowing

- Surface may be nodular or ulcerated, but the mucosa may appear normal

- Contact with biopsy forceps shows a firm, sub-mucous mass

Differential diagnosis

► Advanced esophageal carcinoma can almost always be identified as such on gross inspection.

► Early carcinoma requires differentiation from reflux esophagitis and pure, nonmalignant Barrett epithelium.

Checklist for endoscopic evaluation

► Location relative to the upper esophageal sphincter, aortic constriction, and cardia

► Distance of the upper and lower tumor margins in centimeters from the incisor teeth

► Width of residual lumen

► Circumferential tumor extension

► Consistency

► Mobility of exophytic tumors

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