title: The changing profile of esophageal cancer presentation and its implication for diagnosis.
abstract: 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.
authors.affiliation: Roswell Park Cancer Institute, Department of Surgery, Buffalo, NY 14263, USA. john.gibbs@roswellpark.org
authors.forename: John F
authors.initials: JF
authors.lastname: Gibbs
authors.forename: Ashwani
authors.initials: A
authors.lastname: Rajput
authors.forename: Krishdeep S
authors.initials: KS
authors.lastname: Chadha
authors.forename: Wade G
authors.initials: WG
authors.lastname: Douglas
authors.forename: Hank
authors.initials: H
authors.lastname: Hill
authors.forename: Chukwumere
authors.initials: C
authors.lastname: Nwogu
authors.forename: Hector R
authors.initials: HR
authors.lastname: Nava
authors.forename: Michael S
authors.initials: MS
authors.lastname: Sabel
mesh_terms: 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