The changing profile of esophageal cancer presentation and its implication for diagnosis.
BACKGROUND
The incidence of esophageal adenocarcinoma is rising and has surpassed squamous cell carcinoma.


OBJECTIVE
To determine how the increasing incidence of esophageal adenocarcinoma alters the classic clinical presentation and the implications of these changes for diagnosis.


METHODS
A five-year retrospective review (1991-1996) was made.


METHODS
All patients were identified by a computerized registry search with a diagnosis of esophageal carcinoma.


METHODS
Clinical presentation; duration of symptoms; and correlation with diagnosis, pathology, treatment and outcome.


RESULTS
One-hundred-eight (35%) patients had squamous cell carcinoma and 199 (65%) had adenocarcinoma. Dysphagia and weight loss were more common among patients with squamous cell carcinoma (93% and 68%), when compared to adenocarcinoma (79% and 53%). Twenty-one percent of adenocarcinoma patients had other symptoms presentation, including gastroesophageal reflux disease. Once dysphagia was present, there was no correlation between the duration.of symptoms and survival. However, cancers detected in patients who presented with reflux symptoms without dysphagia showed an improved prognosis over patients who presented with both.


CONCLUSIONS
Esophageal adenocarcinoma has surpassed squamous cell carcinoma. Gastroesophageal reflux was associated with an earlier stage of presentation compared to the "classic" presentation of esophageal cancer.
Gibbs
John F
JF
Roswell Park Cancer Institute, Department of Surgery, Buffalo, NY 14263, USA. john.gibbs@roswellpark.org
Rajput
Ashwani
A
Chadha
Krishdeep S
KS
Douglas
Wade G
WG
Hill
Hank
H
Nwogu
Chukwumere
C
Nava
Hector R
HR
Sabel
Michael S
MS
D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies