Let's move on to our next case.
We have a 76-year-old woman seen in clinic for difficulty swallowing foods for the past two months.
She has a history of GERD for which she has taken omeprazole for the past 12 years.
She has no other past medical history.
She is an on-going smoker and has a 25-pack-year smoking history.
Vitals are normal. Physical exam is unremarkable and labs are normal.
What is the most likely diagnosis?
So she has dysphagia to solid foods which is concerning for a type of mechanical obstruction,
she has a long-standing history of GERD, and she's a tobacco user.
So let's talk a bit about esophageal cancer.
This is the sixth leading cause of worldwide deaths related to cancer.
There are two types; you may have squamous carcinoma or SCC or adenocarcinoma.
In general, it has very poor prognosis.
Because diagnosis is often made in the late stage, patients tend to have five-year survival between 15 and 25%
So here on the right you can see the diagram depicting what areas tend to form squamous cell carcinoma versus adenocarcinoma.
The upper part of the esophagus is prone to developing SCC while the lower part is prone to developing adenocarcinoma.
Patients may present with dysphagia to solids, weight loss, anorexia or lack of hunger, and anemia.
The diagnosis should be made with upper endoscopy along with biopsy.
After that, staging may often be done with a CT scan or PET imaging. In general, treatments, depends on the stage,
but when it is resectable you may do surgery or you may offer neoadjuvant chemoradiation.
So there are many different risk factors for esophageal cancer. It depends on what type.
Here is a list -- a limited list for you to review. I will just point out that Barrett esophagus,
because it's a premalignant condition, places people at risk for adenocarcinoma.
So now let's return to our case.
We have 76-year-old woman who has dysphagia to solid foods which is concerning for a mechanical obstruction,
she also has a long-standing history of GERD and a tobacco user.
What is the best next step in diagnosis?
So putting this all together, she has a high risk for esophageal adenocarcinoma.
The next step should upper endoscopy.
Thank you for your attention.