Gastroenterology · USMLE Step 1 and Step 2

Esophageal Cancer song

Esophageal Cancer - Squamous vs Adeno & Risk, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

Esophageal Cancer

Full song on YouTube ↗Spotify ↗

Key points in this song10

Squamous cell carcinoma arises from the upper and middle thirds of the esophagus and is associated with smoking, alcohol, achalasia, Plummer-Vinson syndrome, and nitrosamine exposure.
Adenocarcinoma arises from the lower third of the esophagus and gastroesophageal junction, and is the most common esophageal cancer in the United States, driven by chronic GERD leading to Barrett esophagus.
Barrett esophagus is the replacement of normal squamous epithelium with intestinal-type columnar epithelium (goblet cells) and is the single most important risk factor for esophageal adenocarcinoma.
The classic presenting symptom of esophageal cancer is progressive dysphagia, beginning with solids and advancing to liquids, accompanied by unintentional weight loss.
Plummer-Vinson syndrome — the triad of iron deficiency anemia, esophageal webs, and dysphagia — predisposes specifically to squamous cell carcinoma of the esophagus.
Upper endoscopy with biopsy is the diagnostic gold standard; CT of the chest and abdomen is used for staging, and endoscopic ultrasound best assesses depth of invasion and lymph node involvement.
Esophageal cancer spreads to regional lymph nodes early due to the absence of a serosal layer, facilitating rapid locoregional dissemination.
Surgical resection (esophagectomy) is the treatment of choice for localized disease; locally advanced disease is treated with concurrent chemoradiation using cisplatin and 5-fluorouracil prior to surgery.
Trastuzumab is added to chemotherapy for HER2-positive metastatic esophageal adenocarcinoma, paralleling its use in HER2-positive gastric cancer.
Overall prognosis is poor with a five-year survival rate below 20%, largely because most patients present with advanced disease at the time of diagnosis.