Esophageal cancer natural history, complications and prognosis

The incidence of esophageal dysplasia turning malignant is very low, especially outside the United States. Complications of esophageal cancer include dysphagia, anemia, and tracheoesophageal fistula. This finding has caused some uncertainty as to the usefulness of screening. Esophageal cancer is associated with a 5 year survival rate of 20%.

• The symptoms of esophageal cancer typically develop insidiously and starts with symptoms such as dysphagia, chest pain and weight loss.^[1]
• If left untreated, patients with esophageal cancer may progress to develop vomiting, aspiration pneumonia and hematemesis.
• Depending on the degree of invasion both squamous cell carcinoma or adenocarcinoma can cause rupture of the esophagus, which can manifest as hematemesis, melena and severe chest pain.
• Ultimately, esophageal cancer can metastasize and be fatal.

Complications can occur as a result of esophageal cancer or because of radiotherapeutic treatment.

• Anemia
• Weight loss
• Dysphagia
• Cachexia
• Aspiration pneumonia
• Metastases

• Tracheoesophageal fistula
• Postradiotherapy esophageal strictures, may lead to recurrent dysphagia.^[2]

Prognosis is generally poor, and the 5-year survival rate of patients with esophageal cancer is approximately 20% for both squamous cell carcinoma and adenocarcinoma of the esophagus.^[3]

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