A 60-year old male pressents with progressive difficulty in swallowing, vomiting and occasional regurgitation for the past 3 months. Barium studies showed marked dilatation of the upper esophagus with narrowing of the lower segment. Manometry showed absent esophageal peristalsis. Which of the following conditions is he most likely at risk of developing?
Correct Answer: Squamous cell carcinoma of the esophagus
Description: Clinical features of Squamous carcinoma of oesophagus Most patients have a history of progressive, painless dysphagia for solid foods. Others present acutely because of food bolus obstruction. In the late stages, weight loss is often extreme; chest pain or hoarseness suggests mediastinal invasion. Fistulation between the oesophagus and the trachea or bronchial tree leads to coughing after swallowing, pneumonia and pleural effusion. Physical signs may be absent but, even at initial presentation,cachexia, cervical lymphadenopathy or other evidence ofmetastatic spread is common. Investigations The investigation of choice is upper gastrointestinal endoscopywith biopsy. A barium swallow demonstrates the site and length of the stricture but adds little useful information. Once a diagnosis has been made, investigations should be performed to stage the tumour and define operability. Thoracic and abdominal CT, often combined with positron emission tomography (PET-CT), should be carried out to identify metastatic spread and local invasion . Invasion of the aoa, major airways or coeliac axis usually precludes surgery, but patients with resectable disease on imaging should undergo EUS to determine the depth of penetration of the tumour into the oesophageal wall and to detect locoregional lymph node involvement . These investigations will define theTNM stage of the disease . Ref Davidson edition23rd pg 797
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