The changing profile of esophageal cancer presentation and its implication for diagnosis.

Abstract:

CONTEXT:The incidence of esophageal adenocarcinoma is rising and has surpassed squamous cell carcinoma. OBJECTIVE:To determine how the increasing incidence of esophageal adenocarcinoma alters the classic clinical presentation and the implications of these changes for diagnosis. DESIGN AND SETTING:A five-year retrospective review (1991-1996) was made. PARTICIPANTS:All patients were identified by a computerized registry search with a diagnosis of esophageal carcinoma. MAIN OUTCOME MEASURES:Clinical presentation; duration of symptoms; and correlation with diagnosis, pathology, treatment and outcome. RESULTS:One-hundred-eight (35%) patients had squamous cell carcinoma and 199 (65%) had adenocarcinoma. Dysphagia and weight loss were more common among patients with squamous cell carcinoma (93% and 68%), when compared to adenocarcinoma (79% and 53%). Twenty-one percent of adenocarcinoma patients had other symptoms presentation, including gastroesophageal reflux disease. Once dysphagia was present, there was no correlation between the duration.of symptoms and survival. However, cancers detected in patients who presented with reflux symptoms without dysphagia showed an improved prognosis over patients who presented with both. CONCLUSIONS:Esophageal adenocarcinoma has surpassed squamous cell carcinoma. Gastroesophageal reflux was associated with an earlier stage of presentation compared to the "classic" presentation of esophageal cancer.

journal_name

J Natl Med Assoc

authors

Gibbs JF,Rajput A,Chadha KS,Douglas WG,Hill H,Nwogu C,Nava HR,Sabel MS

subject

Has Abstract

pub_date

2007-06-01 00:00:00

pages

620-6

issue

6

eissn

0027-9684

issn

1943-4693

journal_volume

99

pub_type

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