 Increase in adenocarcinomas and decreasing squamous cell histology  Squamous cell associated with tobacco, diet (nitrosamines) and alcohol consumption: upper 1/3 esophagus  Adenocarcinoma associated with Barrett’s esophagus: distal esophagus (30 fold increase risk)

 Esophagus is highly distensible; therefore tumors are large before symptoms occur  Dysphagia, odynophagia  Heartburn, reflux  Weight loss

 Esophagus is about 10 inches long  Cancer Begins at the Inner Layer of the Esophageal Wall & Spreads outward  Cancer Spreads thru wall then to the lymph nodes  Types of Cancer  Adenocarcinoma  Squamous Cell  Rare <1%  Neuroendocrine, Sarcoma, Lymphoma

 Age >45, Male 4 x  Tobacco, Alcohol, Barrett’s  Obesity, Lye, Diet low in fruits & vegetables  Achalasia, HPV

 16,000/year  15,000 deaths/ year  18% Survival at 5 years for all  Survival Dependent on Stage

 Barium Swallow, Endoscopy  Endoscopic Ultrasound  Biopsy  Bronchoscopy  CT, MRI, PET

 Surgery  Radiation Therapy, Chemotherapy & Surgery  Radiation Therapy & Chemotherapy  Chemotherapy for Metastatic Disease  Stinting