Squamous Cell Carcinoma of the Esophagus
Presentation
A 63-year-old woman presents to your office with a 3-month history of dysphagia and a 25-pound weight loss. She has an extensive history of tobacco and alcohol abuse. There is no other pertinent past medical or surgical history. On examination, she has no palpable adenopathy, clear lungs, and no hepatomegaly.
Differential Diagnosis
The most likely diagnosis in a patient with dysphagia, weight loss, and social risk factors such as tobacco and alcohol abuse is esophageal cancer. Other possibilities include mediastinal lymphoma with esophageal obstruction and lung cancer with extensive mediastinal adenopathy.
Recommendation
Upper barium swallow, endoscopy, and chest computed tomography (CT) scan.
▪ Barium Swallow
 Figure 39-1 |
Barium Swallow Report
Compression of the esophagus at upper portion. ▪
▪ Endoscopy
 Figure 39-2 |
Endos copy Report
A noncircumferential, moderately obstructing mass in upper thoracic esophagus; biopsies performed. ▪
▪ CT Scan
 Figure 39-3 |
CT Scan Report
Mass in the upper thoracic esophagus with narrowing of the esophageal lumen. No evidence of adenopathy or organ metastases. ▪
Pathology Report
Malignant cells, most consistent with squamous cell cancer. ▪
Diagnosis and Recommendation
Squamous cell cancer of the esophagus with moderate esophageal obstruction. Recommendations include endoscopic ultrasound (EUS) and bronchoscopy.
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