IPLab:Lab 7:Esophagus SCC
Approximately six months prior to admission, this 78-year-old male began having difficulty in swallowing solid food. This difficulty was described as a sticking of the food in his throat and was accompanied by cramping pain which could only be relieved by "coughing up" the ingested food. This dysphagia was accompanied by a twenty-pound weight loss. Following an upper GI series and endoscopic biopsy, the patient was given radiation treatment with considerable improvement. He did well for four months, after which the dysphagia and weight loss increased markedly. He refused operative intervention or further treatment and he died at home two months later.
An autopsy revealed a circumferential fungating mass in the distal third of the esophagus. This mass partially occluded the lumen of the esophagus.
Men. The male-to-female ratio falls in the range of 2:1 to as high as 20:1.
- Deficiency of vitamins A, C, riboflavin, thiamine or pyridoxine;
- deficiency of trace metals (zinc or molybdenum);
- fungal contamination of foodstuffs;
- increases in nitrites/nitrates;
- alcohol consumption (hard liquor is worse than beer or wine);
- tobacco use;
- long-standing esophagitis;
- celiac disease;
- genetic (racial) predisposition.
The rich lymphatic network in the submucosa of the esophagus promotes extensive circumferential and longitudinal spread. Intramural tumor cell clusters are often seen several centimeters away from the main tumor mass. Local extension into adjacent mediastinal structures occurs early and often in this disease and seriously limits the chance of curative resection.
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- Merck Manual: Squamous Cell Carcinoma
- Shibata H, Matsubara O. Apoptosis as an independent prognostic indicator in squamous cell carcinoma of the esophagus. Pathol Int 2001 Jul;51(7):498-503.
- Wu S, Powers S, Zhu W, Hannun YA. Substantial contribution of extrinsic risk factors to cancer development. Nature 2016 Jan 7; 529(7584): 43–47.
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An upper GI series is a series of barium-aided radiographs involving the esophagus, stomach, and duodenum.