Epidemiology and Etiology

Epidemiology

• 11th-most common cancer worldwide and 7th-most common cause of cancer-related deaths
• Risk increases with age, especially during the 6th to 7th decades of life
• Males > females
• Majority of cases fall under 2 types:
  • Adenocarcinoma (AC)
    • Most common form in the United States
    • HigherincidenceIncidenceThe number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time.Measures of Disease Frequency in Caucasians
  • Squamous cell carcinomaSquamous cell carcinomaCutaneous squamous cell carcinoma (cSCC) is caused by malignant proliferation of atypical keratinocytes. This condition is the 2nd most common skin malignancy and usually affects sun-exposed areas of fair-skinned patients. The cancer presents as a firm, erythematous, keratotic plaque or papule.Squamous Cell Carcinoma (SCC) (SCC)
    • Most common form worldwide
    • 90% of esophageal cancers occur in the “esophageal cancer belt” (northern Iran, northern China, CentralAsiaASIASpinal Cord Injuries, and southern Russia)
    • IncidenceIncidenceThe number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time.Measures of Disease Frequency decreasing in the United States
    • HigherincidenceIncidenceThe number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time.Measures of Disease Frequency in African Americans and Asians

Etiology

• Risk factors for adenocarcinoma:
  • Barrett’sesophagusEsophagusThe esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part.Esophagus: Anatomysecondary togastroesophageal reflux diseaseGastroesophageal Reflux DiseaseGastroesophageal reflux disease (GERD) occurs when the stomach acid frequently flows back into the esophagus. This backwash (acid reflux) can irritate the lining of the esophagus, causing symptoms such as retrosternal burning pain (heartburn).Gastroesophageal Reflux Disease (GERD) (GERDGERDGastroesophageal reflux disease (GERD) occurs when the stomach acid frequently flows back into the esophagus. This backwash (acid reflux) can irritate the lining of the esophagus, causing symptoms such as retrosternal burning pain (heartburn).Gastroesophageal Reflux Disease (GERD))
  • ObesityObesityObesity is a condition associated with excess body weight, specifically with the deposition of excessive adipose tissue. Obesity is considered a global epidemic. Major influences come from the western diet and sedentary lifestyles, but the exact mechanisms likely include a mixture of genetic and environmental factors.Obesity
  • SmokingSmokingWillful or deliberate act of inhaling and exhaling smoke from burning substances or agents held by hand.Interstitial Lung Diseases
• Risk factors forsquamous cell carcinomaSquamous cell carcinomaCutaneous squamous cell carcinoma (cSCC) is caused by malignant proliferation of atypical keratinocytes. This condition is the 2nd most common skin malignancy and usually affects sun-exposed areas of fair-skinned patients. The cancer presents as a firm, erythematous, keratotic plaque or papule.Squamous Cell Carcinoma (SCC) (SCC):
  • SmokingSmokingWillful or deliberate act of inhaling and exhaling smoke from burning substances or agents held by hand.Interstitial Lung Diseases
  • Alcohol intake
  • Diet low in vegetables and fruits
  • AchalasiaAchalasiaAchalasia is a primary esophageal motility disorder that develops from the degeneration of the myenteric plexus. This condition results in impaired lower esophageal sphincter relaxation and absence of normal esophageal peristalsis. Patients typically present with dysphagia to solids and liquids along with regurgitation.Achalasia
  • Caustic injuries
  • Human papillomavirusHuman papillomavirusHuman papillomavirus (HPV) is a nonenveloped, circular, double-stranded DNA virus belonging to the Papillomaviridae family. Humans are the only reservoir, and transmission occurs through close skin-to-skin or sexual contact. Human papillomaviruses infect basal epithelial cells and can affect cell-regulatory proteins to result in cell proliferation.Papillomavirus (HPV) infection
  • Atrophic gastritisAtrophic gastritisGastritis with atrophy of the gastric mucosa, the gastric parietal cells, and the mucosal glands leading to achlorhydria. Atrophic gastritis usually progresses from chronic gastritis.Gastritis
  • Tylosis (Howel-Evans syndrome):autosomal dominantAutosomal dominantAutosomal inheritance, both dominant and recessive, refers to the transmission of genes from the 22 autosomal chromosomes. Autosomal dominant diseases are expressed when only 1 copy of the dominant allele is inherited.Autosomal Recessive and Autosomal Dominant Inheritance disease withhyperkeratosisHyperkeratosisIchthyosis Vulgaris of palm and sole 
  • Plummer-Vinson syndromePlummer-Vinson syndromeA syndrome of dysphagia with iron-deficiency anemia that is due to congenital anomalies in the esophagus (such as cervical esophageal webs). It is known as patterson-kelly syndrome in the united kingdom.Iron Deficiency Anemia
  • Poor oral hygiene
  • Nitrosamine exposure (e.g., cured meats)
  • Drinking scalding-hot liquids
  • Areca nut or betel quid chewing

Clinical Presentation and Complications

Clinical presentation

• Asymptomatic in early stages 
• Signs and symptoms:
  • ProgressivedysphagiaDysphagiaDysphagia is the subjective sensation of difficulty swallowing. Symptoms can range from a complete inability to swallow, to the sensation of solids or liquids becoming “stuck.” Dysphagia is classified as either oropharyngeal or esophageal, with esophageal dysphagia having 2 sub-types: functional and mechanical.Dysphagia (from solids to liquids):
    • Due to obstruction by thetumorTumorInflammation
    • Noted when esophageal lumen is < 13 mm
  • Weight lossWeight lossDecrease in existing body weight.Bariatric Surgery(fromdysphagiaDysphagiaDysphagia is the subjective sensation of difficulty swallowing. Symptoms can range from a complete inability to swallow, to the sensation of solids or liquids becoming “stuck.” Dysphagia is classified as either oropharyngeal or esophageal, with esophageal dysphagia having 2 sub-types: functional and mechanical.Dysphagia and tumor-relatedanorexiaAnorexiaThe lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa.Anorexia Nervosa)
  • OdynophagiaOdynophagiaEpiglottitis in 20% ofpatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship

Complications

• Iron-deficiencyanemiaAnemiaAnemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology.Anemia: Overview and Types secondary to chronicgastrointestinal bleedingGastrointestinal bleedingGastrointestinal bleeding (GIB) is a symptom of multiple diseases within the gastrointestinal (GI) tract. Gastrointestinal bleeding is designated as upper or lower based on the etiology’s location to the ligament of Treitz. Depending on the location of the bleeding, the patient may present with hematemesis (vomiting blood), melena (black, tarry stool), or hematochezia (fresh blood in stools).Gastrointestinal Bleeding
• LocaltumorTumorInflammation spread:
  • Cough (tracheaTracheaThe trachea is a tubular structure that forms part of the lower respiratory tract. The trachea is continuous superiorly with the larynx and inferiorly becomes the bronchial tree within the lungs. The trachea consists of a support frame of semicircular, or C-shaped, rings made out of hyaline cartilage and reinforced by collagenous connective tissue.Trachea: Anatomy)
  • HoarsenessHoarsenessAn unnaturally deep or rough quality of voice.Parapharyngeal Abscess and vocal paralysis (recurrent laryngeal nerve)
  • Tracheoesophageal fistulas (direct invasion through the esophageal wall and main stem bronchus)
• MetastasisMetastasisThe transfer of a neoplasm from one organ or part of the body to another remote from the primary site.Grading, Staging, and Metastasis:
  • Compressive symptoms fromlymphLymphThe interstitial fluid that is in the lymphatic system.Secondary Lymphatic Organs nodemetastasisMetastasisThe transfer of a neoplasm from one organ or part of the body to another remote from the primary site.Grading, Staging, and Metastasis (aortic,liverLiverThe liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood.Liver: Anatomy, lung, mediastinal)
  • SCC: usually intrathoracic
  • AC: usually intraabdominal

Diagnosis

Diagnosis

• Initial work-up ofdysphagiaDysphagiaDysphagia is the subjective sensation of difficulty swallowing. Symptoms can range from a complete inability to swallow, to the sensation of solids or liquids becoming “stuck.” Dysphagia is classified as either oropharyngeal or esophageal, with esophageal dysphagia having 2 sub-types: functional and mechanical.Dysphagia:
  • UpperendoscopyEndoscopyProcedures of applying endoscopes for disease diagnosis and treatment. Endoscopy involves passing an optical instrument through a small incision in the skin i.e., percutaneous; or through a natural orifice and along natural body pathways such as the digestive tract; and/or through an incision in the wall of a tubular structure or organ, i.e. Transluminal, to examine or perform surgery on the interior parts of the body.Gastroesophageal Reflux Disease (GERD): Allows for direct visualization andbiopsyBiopsyRemoval and pathologic examination of specimens from the living body.Ewing Sarcoma of lesions
    • Early lesions: superficial plaques, nodules,ulcerationUlcerationCorneal Abrasions, Erosion, and Ulcers, mucosal irregularities
    • Advanced lesions: strictures, masses, obstruction
  • Barium swallowBarium SwallowImaging of the Intestines study: asymmetric narrowing or intraluminal masses 
• EndoscopicbiopsyBiopsyRemoval and pathologic examination of specimens from the living body.Ewing Sarcoma with brush cytology or image-guidedbiopsyBiopsyRemoval and pathologic examination of specimens from the living body.Ewing Sarcoma (for metastatic site):
  • Adenocarcinoma:
    • Mucin-producing intestinal-type mucosa
    • Adjacent Barrett’s mucosa and high-grade dysplasia
  • SCC:
    • KeratinKeratinA class of fibrous proteins or scleroproteins that represents the principal constituent of epidermis; hair; nails; horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms a coiled-coil alpha helical structure consisting of type I keratin and a type II keratin, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. Alpha-keratins have been classified into at least 20 subtypes. In addition multiple isoforms of subtypes have been found which may be due to gene duplication.Seborrheic Keratosis pearls: clusters of neoplastic cells with circular keratinization
    • Individual cell keratinization and intercellular bridges

Evaluation for regional disease andmetastasisMetastasisThe transfer of a neoplasm from one organ or part of the body to another remote from the primary site.Grading, Staging, and Metastasis

• Endoscopic ultrasound (EUS):
  • Most accurate for locoregionalstagingStagingMethods which attempt to express in replicable terms the extent of the neoplasm in the patient.Grading, Staging, and Metastasis
  • Visualizes local disease andtumorTumorInflammation depth
  • Detects regional nodal involvement 
  • Allows forfine needle aspirationFine Needle AspirationFibroadenomabiopsyBiopsyRemoval and pathologic examination of specimens from the living body.Ewing Sarcoma oflymph nodesLymph NodesThey are oval or bean shaped bodies (1 – 30 mm in diameter) located along the lymphatic system.Lymphatic Drainage System: Anatomy
• BronchoscopyBronchoscopyEndoscopic examination, therapy or surgery of the bronchi.Laryngomalacia and Tracheomalacia:
  • Indicated for thoracic esophagealtumorTumorInflammation at or above the carina
  • Helps assessairwayAirwayABCDE Assessment invasion
• Laryngoscopy:
  • Indicated for cervical SCC
  • Determines presence of concomitant SCC of the head andneckNeckThe part of a human or animal body connecting the head to the rest of the body.Peritonsillar Abscess
• Chest and abdominal computed tomography (CT) and/or positron emission tomography (PETPETAn imaging technique that combines a positron-emission tomography (PET) scanner and a ct X ray scanner. This establishes a precise anatomic localization in the same session.Nuclear Imaging)
  • For detection ofmetastasisMetastasisThe transfer of a neoplasm from one organ or part of the body to another remote from the primary site.Grading, Staging, and Metastasis
  • Integrated fluorodeoxyglucose (FDG)-PET/CT available for occultmetastasisMetastasisThe transfer of a neoplasm from one organ or part of the body to another remote from the primary site.Grading, Staging, and Metastasis

StagingStagingMethods which attempt to express in replicable terms the extent of the neoplasm in the patient.Grading, Staging, and Metastasis

TumorTumorInflammation, node,metastasisMetastasisThe transfer of a neoplasm from one organ or part of the body to another remote from the primary site.Grading, Staging, and Metastasis (TNM)stagingStagingMethods which attempt to express in replicable terms the extent of the neoplasm in the patient.Grading, Staging, and Metastasis:

• T:extent oftumorTumorInflammation in the esophageal wall
  • T1: mucosa (innermost layer) and submucosa
  • T2: muscularis propria
  • T3T3A T3 thyroid hormone normally synthesized and secreted by the thyroid gland in much smaller quantities than thyroxine (T4). Most T3 is derived from peripheral monodeiodination of T4 at the 5′ position of the outer ring of the iodothyronine nucleus. The hormone finally delivered and used by the tissues is mainly t3.Thyroid Hormones: adventitia (outermost layer)
  • T4T4The major hormone derived from the thyroid gland. Thyroxine is synthesized via the iodination of tyrosines (monoiodotyrosine) and the coupling of iodotyrosines (diiodotyrosine) in the thyroglobulin. Thyroxine is released from thyroglobulin by proteolysis and secreted into the blood. Thyroxine is peripherally deiodinated to form triiodothyronine which exerts a broad spectrum of stimulatory effects on cell metabolism.Thyroid Hormones: involves adjacent structures of theesophagusEsophagusThe esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part.Esophagus: Anatomy
• N:regionallymphLymphThe interstitial fluid that is in the lymphatic system.Secondary Lymphatic Organsnodes involved
• M:presence of distantmetastasisMetastasisThe transfer of a neoplasm from one organ or part of the body to another remote from the primary site.Grading, Staging, and Metastasis

Management and Prognosis

Curative treatment options

• Endoscopic mucosal resection: 
  • For early cancer (limited to mucosa) or high-grade dysplasia (HGD) in Barrett’sesophagusEsophagusThe esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part.Esophagus: Anatomy
  • Lesion with diameter ≤ 2 cm
  • < ⅓ of the circumference of the esophageal wall involved
• Surgery:
  • Esophagectomy:
    • Lesion penetrating up to the submucosa (T1 with no regionallymph nodesLymph NodesThey are oval or bean shaped bodies (1 – 30 mm in diameter) located along the lymphatic system.Lymphatic Drainage System: Anatomy, nometastasisMetastasisThe transfer of a neoplasm from one organ or part of the body to another remote from the primary site.Grading, Staging, and Metastasis)
    • In some centers, lesions penetrating up to muscularis propria (T2) can be resected.
  • Esophagectomy followingneoadjuvant chemotherapyNeoadjuvant ChemotherapyOsteosarcoma or followed by chemoradiotherapy:
    • For locally advanced tumors (T3T3A T3 thyroid hormone normally synthesized and secreted by the thyroid gland in much smaller quantities than thyroxine (T4). Most T3 is derived from peripheral monodeiodination of T4 at the 5′ position of the outer ring of the iodothyronine nucleus. The hormone finally delivered and used by the tissues is mainly t3.Thyroid Hormones) with or without nodal disease
    • SelectedpatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship withT4T4The major hormone derived from the thyroid gland. Thyroxine is synthesized via the iodination of tyrosines (monoiodotyrosine) and the coupling of iodotyrosines (diiodotyrosine) in the thyroglobulin. Thyroxine is released from thyroglobulin by proteolysis and secreted into the blood. Thyroxine is peripherally deiodinated to form triiodothyronine which exerts a broad spectrum of stimulatory effects on cell metabolism.Thyroid Hormones disease
  • Contraindication to surgery:
    • MetastasisMetastasisThe transfer of a neoplasm from one organ or part of the body to another remote from the primary site.Grading, Staging, and Metastasis to other organs or extraregionallymphLymphThe interstitial fluid that is in the lymphatic system.Secondary Lymphatic Organs node spread
  • AdjuvantAdjuvantSubstances that augment, stimulate, activate, potentiate, or modulate the immune response at either the cellular or humoral level. The classical agents (freund’s adjuvant, bcg, corynebacterium parvum, et al.) contain bacterial antigens. Some are endogenous (e.g., histamine, interferon, transfer factor, tuftsin, interleukin-1). Their mode of action is either non-specific, resulting in increased immune responsiveness to a wide variety of antigens, or antigen-specific, i.e., affecting a restricted type of immune response to a narrow group of antigens. The therapeutic efficacy of many biological response modifiers is related to their antigen-specific immunoadjuvanticity.Vaccination therapy after surgery:
    • After neoadjuvant chemoradiation and surgery,patientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship with pathologic complete response (pCRPCRPolymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules.Polymerase Chain Reaction (PCR)) do not require further therapy.
    • For those with residual disease after neoadjuvant therapy,adjuvantAdjuvantSubstances that augment, stimulate, activate, potentiate, or modulate the immune response at either the cellular or humoral level. The classical agents (freund’s adjuvant, bcg, corynebacterium parvum, et al.) contain bacterial antigens. Some are endogenous (e.g., histamine, interferon, transfer factor, tuftsin, interleukin-1). Their mode of action is either non-specific, resulting in increased immune responsiveness to a wide variety of antigens, or antigen-specific, i.e., affecting a restricted type of immune response to a narrow group of antigens. The therapeutic efficacy of many biological response modifiers is related to their antigen-specific immunoadjuvanticity.VaccinationnivolumabNivolumabA genetically engineered, fully humanized immunoglobulin g4 monoclonal antibody that binds to the pd-1 receptor, activating an immune response to tumor cells. It is used as monotherapy or in combination with ipilimumab for the treatment of advanced malignant melanoma. It is also used in the treatment of advanced or recurring non-small cell lung cancer; renal cell carcinoma; and Hodgkin’s lymphoma.Melanoma for up to one year is recommended.
    • InpatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship who undergo upfront surgery without neoadjuvant therapy,adjuvantAdjuvantSubstances that augment, stimulate, activate, potentiate, or modulate the immune response at either the cellular or humoral level. The classical agents (freund’s adjuvant, bcg, corynebacterium parvum, et al.) contain bacterial antigens. Some are endogenous (e.g., histamine, interferon, transfer factor, tuftsin, interleukin-1). Their mode of action is either non-specific, resulting in increased immune responsiveness to a wide variety of antigens, or antigen-specific, i.e., affecting a restricted type of immune response to a narrow group of antigens. The therapeutic efficacy of many biological response modifiers is related to their antigen-specific immunoadjuvanticity.VaccinationchemotherapyChemotherapyOsteosarcoma is recommended for node-positive or pathologic T3-4 disease.
• Chemoradiation:
  • Use ofradiationRadiationEmission or propagation of acoustic waves (sound), electromagnetic energy waves (such as light; radio waves; gamma rays; or x-rays), or a stream of subatomic particles (such as electrons; neutrons; protons; or alpha particles).Osteosarcoma therapy andchemotherapyChemotherapyOsteosarcoma 
  • For downstaging thetumorTumorInflammation for later resection or as definitive treatment
  • 2–3 drugcytotoxicCytotoxicParvovirus B19 regimen used due to higher response rate

Palliative options

• For advanced esophageal cancer (metastatic disease)
• Goals:
  • Symptom palliation and comfort
  • Prolong survival 
• Chemoradiation 
• Assess for positiveHER2HER2A cell surface protein-tyrosine kinase receptor that is overexpressed in a variety of adenocarcinomas. It has extensive homology to and heterodimerizes with the EGF receptor, the ERBB-3 receptor, and the ERBB-4 receptor. Activation of the erbB-2 receptor occurs through heterodimer formation with a ligand-bound erbB receptor family member.Targeted and Other Nontraditional Antineoplastic Therapy(human epidermal growth factor 2)status of adenocarcinoma: addtrastuzumabTrastuzumabA humanized monoclonal antibody against the ErbB-2 receptor (HER2). As an antineoplastic agent, it is used to treat breast cancer where HER2 is overexpressed.Targeted and Other Nontraditional Antineoplastic Therapy, a monoclonal antibody targeting theHER2HER2A cell surface protein-tyrosine kinase receptor that is overexpressed in a variety of adenocarcinomas. It has extensive homology to and heterodimerizes with the EGF receptor, the ERBB-3 receptor, and the ERBB-4 receptor. Activation of the erbB-2 receptor occurs through heterodimer formation with a ligand-bound erbB receptor family member.Targeted and Other Nontraditional Antineoplastic TherapyreceptorReceptorReceptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell.Receptors
• Endoscopic procedures:
  • Dilation
  • Stenting
  • Laser ablation

PrognosisPrognosisA prediction of the probable outcome of a disease based on a individual’s condition and the usual course of the disease as seen in similar situations.Non-Hodgkin Lymphomas

• Depends on the stage of disease
• 50%–80% ofpatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship on presentation have locally advanced or metastatic esophageal cancer.
• Low survival rate noted inpatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship withlymphLymphThe interstitial fluid that is in the lymphatic system.Secondary Lymphatic Organs node or distantmetastasisMetastasisThe transfer of a neoplasm from one organ or part of the body to another remote from the primary site.Grading, Staging, and Metastasis 
• Overexpression ofHER2HER2A cell surface protein-tyrosine kinase receptor that is overexpressed in a variety of adenocarcinomas. It has extensive homology to and heterodimerizes with the EGF receptor, the ERBB-3 receptor, and the ERBB-4 receptor. Activation of the erbB-2 receptor occurs through heterodimer formation with a ligand-bound erbB receptor family member.Targeted and Other Nontraditional Antineoplastic TherapyreceptorReceptorReceptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell.Receptors: associated with aggressive cancer growth and poor survival

Differential Diagnosis

• Barrett’sesophagusEsophagusThe esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part.Esophagus: Anatomy:results from chronicgastroesophageal reflux diseaseGastroesophageal Reflux DiseaseGastroesophageal reflux disease (GERD) occurs when the stomach acid frequently flows back into the esophagus. This backwash (acid reflux) can irritate the lining of the esophagus, causing symptoms such as retrosternal burning pain (heartburn).Gastroesophageal Reflux Disease (GERD) (GERDGERDGastroesophageal reflux disease (GERD) occurs when the stomach acid frequently flows back into the esophagus. This backwash (acid reflux) can irritate the lining of the esophagus, causing symptoms such as retrosternal burning pain (heartburn).Gastroesophageal Reflux Disease (GERD)) leading to replacement of esophageal squamousepitheliumEpitheliumThe epithelium is a complex of specialized cellular organizations arranged into sheets and lining cavities and covering the surfaces of the body. The cells exhibit polarity, having an apical and a basal pole. Structures important for the epithelial integrity and function involve the basement membrane, the semipermeable sheet on which the cells rest, and interdigitations, as well as cellular junctions.Surface Epithelium: Histology by gastric columnarepitheliumEpitheliumThe epithelium is a complex of specialized cellular organizations arranged into sheets and lining cavities and covering the surfaces of the body. The cells exhibit polarity, having an apical and a basal pole. Structures important for the epithelial integrity and function involve the basement membrane, the semipermeable sheet on which the cells rest, and interdigitations, as well as cellular junctions.Surface Epithelium: Histology. Barrett’sesophagusEsophagusThe esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part.Esophagus: Anatomy is a risk factor for esophageal adenocarcinoma.SurveillanceSurveillanceDevelopmental Milestones and Normal Growth is recommended to detect dysplasia or adenocarcinoma early enough to provide treatment.
• EsophagealstrictureStricturePrimary Sclerosing Cholangitis: narrowing of theesophagusEsophagusThe esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part.Esophagus: Anatomy that can result fromGERDGERDGastroesophageal reflux disease (GERD) occurs when the stomach acid frequently flows back into the esophagus. This backwash (acid reflux) can irritate the lining of the esophagus, causing symptoms such as retrosternal burning pain (heartburn).Gastroesophageal Reflux Disease (GERD), malignancies, andcaustic ingestionCaustic IngestionCaustic agents are acidic or alkaline substances that damage tissues severely if ingested. Alkali ingestion typically damages the esophagus via liquefactive necrosis, whereas acids cause more severe gastric injury leading to coagulative necrosis.Caustic Ingestion (Cleaning Products). The condition presents withdysphagiaDysphagiaDysphagia is the subjective sensation of difficulty swallowing. Symptoms can range from a complete inability to swallow, to the sensation of solids or liquids becoming “stuck.” Dysphagia is classified as either oropharyngeal or esophageal, with esophageal dysphagia having 2 sub-types: functional and mechanical.Dysphagia to solids, progressing to liquids.Barium swallowBarium SwallowImaging of the Intestines study shows a narrowed luminal diameter. UpperendoscopyEndoscopyProcedures of applying endoscopes for disease diagnosis and treatment. Endoscopy involves passing an optical instrument through a small incision in the skin i.e., percutaneous; or through a natural orifice and along natural body pathways such as the digestive tract; and/or through an incision in the wall of a tubular structure or organ, i.e. Transluminal, to examine or perform surgery on the interior parts of the body.Gastroesophageal Reflux Disease (GERD) allows forbiopsyBiopsyRemoval and pathologic examination of specimens from the living body.Ewing Sarcoma and dilation when necessary.
• Esophageal spasm: presents withdysphagiaDysphagiaDysphagia is the subjective sensation of difficulty swallowing. Symptoms can range from a complete inability to swallow, to the sensation of solids or liquids becoming “stuck.” Dysphagia is classified as either oropharyngeal or esophageal, with esophageal dysphagia having 2 sub-types: functional and mechanical.Dysphagia to solids and liquids but is associated with sudden onset of chestpainPainAn unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons.Pain: Types and Pathways that is not exertion-related. There are 2 types of esophageal spasm: distal esophageal spasm and hypercontractileesophagusEsophagusThe esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part.Esophagus: Anatomy.ManometryManometryMeasurement of the pressure or tension of liquids or gases with a manometer.Achalasia shows characteristic esophageal contractions with normal relaxation of theesophagogastric junctionEsophagogastric junctionThe area covering the terminal portion of esophagus and the beginning of stomach at the cardiac orifice.Esophagus: Anatomy. 
• AchalasiaAchalasiaAchalasia is a primary esophageal motility disorder that develops from the degeneration of the myenteric plexus. This condition results in impaired lower esophageal sphincter relaxation and absence of normal esophageal peristalsis. Patients typically present with dysphagia to solids and liquids along with regurgitation.Achalasia: anesophageal motilityEsophageal MotilityGastrointestinal Motility disorder that develops from degeneration of themyenteric plexusMyenteric plexusOne of two ganglionated neural networks which together form the enteric nervous system. The myenteric (Auerbach’s) plexus is located between the longitudinal and circular muscle layers of the gut. Its neurons project to the circular muscle, to other myenteric ganglia, to submucosal ganglia, or directly to the epithelium, and play an important role in regulating and patterning gut motility.Gastrointestinal Neural and Hormonal Signaling. There is impairedlower esophageal sphincterLower Esophageal SphincterEsophagus: Anatomy relaxation and absence of normal esophagealperistalsisPeristalsisA movement, caused by sequential muscle contraction, that pushes the contents of the intestines or other tubular organs in one direction.Gastrointestinal Motility.PatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship present withdysphagiaDysphagiaDysphagia is the subjective sensation of difficulty swallowing. Symptoms can range from a complete inability to swallow, to the sensation of solids or liquids becoming “stuck.” Dysphagia is classified as either oropharyngeal or esophageal, with esophageal dysphagia having 2 sub-types: functional and mechanical.Dysphagia to solids and liquids along withregurgitationRegurgitationGastroesophageal Reflux Disease (GERD). Diagnosis is established by high-resolutionmanometryManometryMeasurement of the pressure or tension of liquids or gases with a manometer.Achalasia. 
• Esophageal ring and web:thin structures that produce partial occlusion of the esophageal lumen.Plummer-Vinson syndromePlummer-Vinson syndromeA syndrome of dysphagia with iron-deficiency anemia that is due to congenital anomalies in the esophagus (such as cervical esophageal webs). It is known as patterson-kelly syndrome in the united kingdom.Iron Deficiency Anemia consists of iron-deficiencyanemiaAnemiaAnemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology.Anemia: Overview and Types,dysphagiaDysphagiaDysphagia is the subjective sensation of difficulty swallowing. Symptoms can range from a complete inability to swallow, to the sensation of solids or liquids becoming “stuck.” Dysphagia is classified as either oropharyngeal or esophageal, with esophageal dysphagia having 2 sub-types: functional and mechanical.Dysphagia, and a cervical esophageal web. Schatzki’s ring is the most common type of esophageal ring.PatientsPatientsIndividuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.Clinician–Patient Relationship present withdysphagiaDysphagiaDysphagia is the subjective sensation of difficulty swallowing. Symptoms can range from a complete inability to swallow, to the sensation of solids or liquids becoming “stuck.” Dysphagia is classified as either oropharyngeal or esophageal, with esophageal dysphagia having 2 sub-types: functional and mechanical.Dysphagia to solids. Diagnosis is bybarium swallowBarium SwallowImaging of the Intestines study and upperendoscopyEndoscopyProcedures of applying endoscopes for disease diagnosis and treatment. Endoscopy involves passing an optical instrument through a small incision in the skin i.e., percutaneous; or through a natural orifice and along natural body pathways such as the digestive tract; and/or through an incision in the wall of a tubular structure or organ, i.e. Transluminal, to examine or perform surgery on the interior parts of the body.Gastroesophageal Reflux Disease (GERD).

References

1. Reddy, A. T., & Patel, A. (2025).Deciphering dysphagia in clinical practice: A case-based review. Gastroenterology & Endoscopy News. https://www.gastroendonews.com/Review-Articles/Article/06-25/Esophageal-Dysphagia-Evaluation-Management/77419
2. Kim, H. W., & Park, S. Y. (2024).Current trends in the epidemiology and treatment of esophageal cancer in South Korea. Journal of Chest Surgery, 58(1), 15–20.https://doi.org/10.5090/jcs.24.078
3. Abbas, G., Krasna, M. (2017). Overview of esophageal cancer.Ann Cardiothorac Surg 6(2):131–136.https://pubmed.ncbi.nlm.nih.gov/28447001/ 
4. Gibson, M. K. (2025). Epidemiology and risk factors for esophageal cancer.UpToDate. Retrieved January 21, 2026, fromhttps://www.uptodate.com/contents/epidemiology-and-risk-factors-for-esophageal-cancer
5. Jain, S., Dhingra, S. (2017). Pathology of esophageal cancer and Barrett’s esophagus.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387146/
6. Kumar, V., Abbas, A.K., Aster, J. (2020). The gastrointestinal tract inRobbins and Cotran Pathologic Basis of Disease (10th ed., pp. 762–764), Elsevier, Inc.
7. Telvizian, T. (2025).Esophageal cancer. Medscape. Retrieved January 21, 2026, fromhttps://emedicine.medscape.com/article/277930-overview
8. Wang, Y., Mukkamalla, S. K. R., Singh, R., & Lyons, S. (2024).Esophageal cancer. In StatPearls. StatPearls Publishing. Retrieved January 21, 2026, from https://www.ncbi.nlm.nih.gov/books/NBK459267/
9. Saltzman, J. R., Gibson, M. K., & Sachdeva, U. M. (2025).Clinical presentation, diagnosis, and staging of esophageal cancer. In R. T. Shroff (Ed.), UpToDate. Wolters Kluwer. Retrieved January 21, 2026, from https://www.uptodate.com/contents/clinical-presentation-diagnosis-and-staging-of-esophageal-cancer
10. Smyth, E. C., Lagergren, J., Fitzgerald, R. C., Lordick, F., Shah, M. A., Lagergren, P., & Cunningham, D. (2017).Oesophageal cancer.Nature Reviews Disease Primers, 3, Article 17048.https://doi.org/10.1038/nrdp.2017.48
11. Swofford, B., Dragovich, T. (2017). Durable and Complete Response to Herceptin Monotherapy in Patients with Metastatic Esophageal Cancer.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803686/
12. Wright, C., Saltzman, J., Tanabe, K., Savarese, D. (2024). Management of superficial esophageal cancer. Retrieved January 21, 2026, fromhttps://www.uptodate.com/contents/management-of-superficial-esophageal-cancer