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Esophageal Cancer

Patient Presents

Arden is a 37-year-old white male who presents to his family doctor and is referred to the radiation oncology department for consultation.

Chief complaint: Heartburn for "a long time" and difficulty swallowing during the past 4 or 5 months. Occasionally food seems to "hang up" in his throat. He points to the upper portion of his neck, directly beneath his chin. Pain immediately below the sternum that feels like "a gnawing or burning."

Other complaints: Weight loss of 33 pounds in the past 6 or 7 months, weakness, coughing at night. (Usual weight: 230 pounds).

Other information: Does not use tobacco; alcohol intake does not exceed 2 cans of beer per week. Has treated stomach pain with otc (over the counter) medications for acid stomach.

Students should identify: dysphagia, gastric reflux, cachexia, respiratory component, habits.

Define and describe GERD.

Identify structures surrounding or in close proximity to the distal esophagus that could be involved in this disease.

What is the relationship of weight loss to prognosis in malignant diseases?

What are acceptable hypotheses?