ESOPHAGEAL ADENOCARCINOMA

Presents with progressive dysphagia, nausea, and vomiting
Associated symptoms: weight loss, increasing fatigue

Differential Diagnosis:

Dysphagia

• Functional obstruction
• Motility disorders (Scleroderma, Achalasia, Chagas disease, Diffuse esophageal spasm, Diabetes)
• Esophagitis (Reflux, Infections, Corrosive, Alcoholism)
• Mechanical Obstruction
• Luminal (Foreign body)
• Wall (Benign tumors, Malignant tumors, Strictures, Congenital webs and rings, Diverticuli)
• Outside (Vascular anomalies, Lymphadenopathy)

Adenocarcinoma on Ba SW

Classic Appearance

• Early adenocarcinoma - Focal nodularity, small polyps, plaque-like lesions, sometimes within pre-existing peptic stricture

• Advanced disease

• Infiltrating: long area of irregular narrowing, mucosal nodularity, ulceration, shelf-like borders
• Polypoid: fungating intraluminal masses, irregular areas of ulceration
• Ulcerative: large ulcer with tumor rim, can be confused with benign ulcer
• Varicoid: less common, serpiginous, fixed submucosal defects that mimic varices on still films

Associated Features

• Hiatal hernia (80%)
• Gastroesophageal reflux (48%)
• Peptic stricture (20%)

Dilated esophagus proximal to tumor