Endoscopy is mandatory and is used to visualize the neoplasia as well as to obtain a biopsy sample.
A barium swallow is typically performed first in the workup for this type of neoplasia.
On a barium swallow, the imaging findings resemble an apple core. This occurs because the tumor invades the esophageal lumen creating a narrow path for the barium to progress. The "core" shows the barium that has progressed through the narrow lumen and the darker shaded part shows the surrounding tumor.
Endoscopic ultrasound is often used for staging.
A CT scan is used to evaluate the characteristics of the neoplasia, the degree of invasion into the surrounding tissues, and the presence of distant metastases. These factors ultimately help in staging the tumor.
Chemotherapy and Radiation are used to treat this neoplasm. Chemotherapeutic regimen varies from patient to patient. Locally metastatic disease is typically managed with 5-fluorouracil in combination with radiation.
Surgical resection is the only definitive treatment in cases in which the disease is localized only to the esophagus or minimally invasive.
Esophageal stenosis is a serious complication of long-standing inflammation since the tumor invades both the cell layers lining the esophagus as well as its lumen.
The tumor can invade adjacent tissues such as the trachea or even the bronchi. As barriers are eroded, fistulae can develop. Clinical signs of TEF include dry cough and hemoptysis.
The prognosis is typically grave. Patients typically present in advanced stages of the disease and the five year survival rate is estimated to be between 5-20%.
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