Esophageal Cancer for the NP Exam
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Esophageal Cancer for Nurse Practitioner Licensing Exam
Definition
- Esophageal Cancer: Malignancy of the esophagus, primarily categorized into two types:
- Squamous Cell Carcinoma (SCC): Arises from the squamous epithelium, most common worldwide.
- Adenocarcinoma: Originates from glandular cells, typically in the distal esophagus, associated with Barrett’s esophagus and GERD.
Risk Factors
- Squamous Cell Carcinoma:
- Tobacco and alcohol use: Key risk factors.
- Hot beverages: Chronic irritation.
- Achalasia: Increased risk due to food stasis.
- Low fruit/vegetable intake.
- Adenocarcinoma:
- GERD and Barrett’s Esophagus: Chronic reflux leads to Barrett’s esophagus, a precancerous condition.
- Obesity: Increases intra-abdominal pressure, promoting reflux.
- Smoking: Also linked to adenocarcinoma.
Clinical Features
- Dysphagia: Progressive difficulty swallowing, starting with solids and advancing to liquids.
- Weight Loss: Significant unintentional weight loss due to dysphagia and cancer-associated cachexia.
- Odynophagia: Pain with swallowing.
- Chest Pain: Non-specific retrosternal discomfort or pain.
- Hoarseness: Recurrent laryngeal nerve involvement in advanced disease.
- GI Bleeding: Hematemesis or melena from tumor ulceration.
Diagnosis
- Endoscopy with Biopsy:
- Esophagogastroduodenoscopy (EGD) is the gold standard for diagnosing esophageal cancer. Biopsy confirms the histological type.
- Barium Swallow:
- May reveal an apple-core lesion or stricture, indicating obstruction.
- Imaging (CT or PET/CT):
- Used for staging to assess local invasion and distant metastasis.
Treatment
- Surgical Resection:
- Esophagectomy: Removal of part or all of the esophagus is the main treatment for localized disease.
- Neoadjuvant Chemoradiotherapy:
- Preoperative chemoradiation is often used to shrink the tumor in locally advanced disease.
- Palliative Care:
- For advanced disease, treatment focuses on symptom management, such as esophageal stenting to relieve dysphagia.
Complications
- Local Invasion: Can lead to tracheoesophageal fistula or compression of nearby structures.
- Distant Metastasis: Common sites include the liver, lungs, and lymph nodes.
- Malnutrition: Due to dysphagia and reduced intake.
Key Points
- Esophageal cancer is primarily classified as squamous cell carcinoma or adenocarcinoma, with risk factors including smoking, alcohol, and GERD.
- Symptoms include progressive dysphagia, weight loss, chest pain, and GI bleeding.
- Diagnosis is made via endoscopy with biopsy, and treatment depends on staging, often involving esophagectomy and chemoradiation.
- Prevention strategies include smoking cessation, alcohol moderation, and managing GERD to reduce the risk of adenocarcinoma.