Difficult to swallow

A 54-year-old Caucasian man presents with progressive dysphagia for 3 months. This is only to solids, and is associated with a sensation of food getting stuck in the middle of his chest. He has also lost 10 pounds of weight over the past three months.

He does not take any medications presently, and specifically, has never taken medications for heartburn. However, further questioning reveals that he has experienced multiple episodes of regurgitant material coming up to his throat, especially at night, for several years now.

His medical and family histories are otherwise unremarkable. He is an active smoker with a greater than 30 pack year smoking history and drinks alcohol socially.

Select Relevant Investigations
Barium Esophagogram

Performed

There is a focal area of luminal narrowing in the distal third of the esophagus.
Upper GI Endoscopy

Performed

An intraluminal ulcerating mass is found in the distal third of the esophagus. The stomach and duodenum appear normal. Histology of biopsies of the mass is in keeping with a grade 3 (poorly differentiated) esophageal adenocarcinoma.

Subsequent endoscopic ultrasound (EUS) reveals that the tumor has infiltrated the adventitia of the esophagus.
CT Thorax + Abdomen

Performed

There is no evidence of solid tumor metastasis or lymphadenopathy in the thorax, abdomen, or pelvis.
H. pylori serology

Performed

H. pylori serology is negative

Select Relevant Management
Esophagectomy
Chemotherapy
Radiotherapy
Endoscopic dilatation and stenting