Presentation

Esophageal carcinoma typically occurs in the sixth or seventh decades of life with a history of excessive use of tobacco and alcohol is common. Symptoms from esophageal carcinoma may be of insidious onset, beginning as nonspecific retrosternal discomfort or indigestion. As the tumor enlarges, symptoms progress with weight loss, odynophagia, chest pain, and occasionally hematemesis. Dysphagia is the presenting complaint in 80% to 90% of patients with esophageal carcinoma. Any adult who complains of progressive dysphagia warrants both a barium esophagogram and esophagoscopy to rule out carcinoma.

Table 10.2. Results of preoperative adjuvant therapy for esophageal cancer

Preoperative

Patients Adjuvant Therapy Resectable Median Survival

Gignoux 1987 102 XRT 73% 11 mo

Roth 1988 17 Chemo 72% 10 mo

Orringer 1990 43 Chemo/XRT 91% 29 mo

Walsh 1996 58 Chwmo/XRT 90% 16 mo

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