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

John F. Gibbs, Ashwani Rajput, Krishdeep S. Chadha, Wade G. Douglas, Hank Hill, Chukwumere Nwogu, Hector R. Nava, Michael S. Sabel

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)620-626
Number of pages7
JournalJournal of the National Medical Association
Volume99
Issue number6
StatePublished - Jun 2007
Externally publishedYes

Keywords

  • Cancer
  • Esophagus
  • Gastroesophageal reflux disease
  • Survival
  • Symptoms

ASJC Scopus subject areas

  • Medicine(all)

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