Esophageal cancer differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Esophageal cancer}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Esophageal_cancer]]
{{CMG}}{{AE}}{{PSD}}
{{CMG}}{{AE}}{{PSD}}{{HM}}


==Overview==
==Overview==
Esophageal cancer must be differentiated from *[[gastroesophageal reflux disease]] (GERD), [[Barrett's esophagus]], [[esophageal achalasia]], [[gastritis]], [[gastric ulcer]], and [[stomach cancer]].
Esophageal cancer must be differentiated from [[gastroesophageal reflux disease]] (GERD), [[Barrett's esophagus]], [[esophageal achalasia]], [[gastritis]], [[gastric ulcer]], and [[stomach cancer]].
==Differentiating Esophageal cancer from other Diseases==
==Differentiating Esophageal cancer from other Diseases==
 
===Approach to dysphasia===
*[[Gastroesophageal reflux disease]] (GERD)
{{familytree/start}}
 
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | |A01=Dysphagia}}
*[[Barrett's esophagus]]  
{{familytree | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|-|-|-|.| | }}
 
{{familytree | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | | | | | | B02 | |B01=Oropharyngeal dysphagia|B02=Esophageal dysphagia|}}
*[[Esophageal achalasia]]
{{familytree | | | | | | | |,|-|-|-|^|-|-|-|-|-|-|-|-|-|-|.| | | | | | | | | | | | |,|-|-|-|^|-|-|-|-|-|-|-|.| | |}}
 
{{familytree | | | | | | | C01 | | | | | | | | | | | | | C02 | | | | | | | | | | | C03 | | | | | | | | | | C04 | |C01=Solids only|C02=Solids and Liquids|C03=Solids only|C04=Solids and Liquids|}}
*[[Gastritis]]
{{familytree | | | | | | | |!| | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | |!| | | | | | | | | | | |!| | | |}}
*[[Gastric ulcer]]  
{{familytree | | | | | | | D01 | | | | | | | | | | D02 | | | | D03 | | | | | | | | D04 | | | | | | | | | | D05 | | |D01=<div align="left">❑Zenker's diverticulum<br>❑Neoplasm<br>❑Webs</div>|D02=Neurogenic|D03=Myogenic|D04=Pain|D05=<div align="left">❑Achalasia<br>❑Scleroderma<br>❑DES</div>|}}
*[[Stomach cancer]]
{{familytree | | | | | | | |!| | | | | | | | | | | |!| | | | | |!| | | | | | |,|-|-|^|-|-|-|.| | | | | | | |!| | | |}}
{{familytree | | | | | | | |!| | | | | | | | | | | |!| | | | | E01 | | | | | E02 | | | | | E03 | | | | | | E04 | |E01=<div align="left">❑Myasthenia gravis<br>❑Connective tissue disorder<br>❑Myotonic dystrophy</div>|E02=No|E03=Yes|E04=<div align="left">❑Heart burn</div>|}}
{{familytree | | | | | | | F01 | | | | | | | | | | F02 | | | | | | | | | | | |!| | | | | | |!| | | | |,|-|-|^|-|-|.| |F01=Barium swallow|F02=Mental status|}}
{{familytree | | | | | | | |!| | | | | | | | |,|-|-|^|-|-|.| | | | | | |,|-|-|^|-|-|.| | | G01 | | | G02 | | | | G03 | |G01=<div align="left">❑Pill esophagitis<br>❑Caustic injury<br>❑Chemotherapy</div>|G02=Yes|G03=No|}}
{{familytree | | |,|-|-|-|-|+|-|-|-|-|.| | | H01 | | | | H02 | | | | | H03 | | | | H04 | | | | | | | |!| | | | | |!| | |H01=Impaired|H02=Normal|H03=Non progressive|H04=Progressive|}}
{{familytree | | I01 | | | I02 | | | I03 | | |!| | | | | |!| | | | | | |!| | | | | |!| | | | | | | | I04 | | | | I05 |  I01=Sac|I02=Webs|I03=Mass|I04=<div align="left">❑Scleroderma</div>|I05=<div align="left">❑Achalasia<br>❑DES</div>|}}
{{familytree | | |!| | | | |!| | | | |!| | | J01 | | | | J02 | | | | | J03 | | | | J04 | | | | | | | | | | | | | |!| |J01=<div align="left">❑Stroke</div>|J02=<div align="left">❑ALS<br>❑Parkinsonism</div>|J03=<div align="left">❑Rings<br>❑Webs</div>|J04=<div align="left">❑Strictures<br>❑Cancer</div>|}}
{{familytree | | K01 | | | K02 | | | K03 | | | | | | | | | | | | | | | |!| | | | | |!| | | | | | | | | | | | | | K04 |K01=<div align="left">❑Zenker's diverticulum</div>|K02=<div align="left">❑Plummer-Vinson syndrome</div>|K03=<div align="left">❑Carcinoma</div>|K04=Chest pain and manometry|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | L01 | | | | L02 | | | | | | | | | | | | | |!| |L01=Barium swallow|L02=Weight loss|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| | |!| | | | | | | | | | | | | | M01 | |M01=Increase LES pressure|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | N01 | | | | N02 | |!| | | | | | | | | | | |,|-|-|^|-|-|.| |N01=<div align="left">❑Rings</div>|N02=<div align="left">❑Webs</div>|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | | O01 | | | | O02 | | |O01=Yes|O02=No|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | P01 | | | | P02 | | | | | | | |!| | | | | |!| | P01=Rapid|P02=Slow|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | |!| | | | | | | | Q01 | | | | Q02 | |Q01=<div align="left">❑Achalasia</div>|Q02=<div align="left">❑DES</div>|}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | R01 | | | | R02 | | | | | | |R01=<div align="left">❑Esophageal cancer</div>|R02=<div align="left">❑Strictures/GERD</div>|}}
{{familytree/end}}
===Differentiating Esophageal cancer from other Diseases===
*Esophageal adenocarcinoma must be differentiated from other causes of [[dysphagia]], [[odynophagia]] and food regurgitation such as [[Gastroesophageal reflux disease|GERD]], [[esophageal stricture]], [[reflux esophagitis]], [[systemic sclerosis]], [[esophageal spasm]], [[pseudoachalasia]], [[stroke]], [[esophageal candidiasis]] and [[Chagas disease]].<ref>{{cite book | last = Ferri | first = Fred | title = Ferri's clinical advisor 2015 : 5 books in 1 | publisher = Elsevier/Mosby | location = Philadelphia, PA | year = 2015 | isbn = 978-0323083751 }}</ref><ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }}</ref><ref name="pmid25133039">{{cite journal |vauthors=Badillo R, Francis D |title=Diagnosis and treatment of gastroesophageal reflux disease |journal=World J Gastrointest Pharmacol Ther |volume=5 |issue=3 |pages=105–12 |year=2014 |pmid=25133039 |pmc=4133436 |doi=10.4292/wjgpt.v5.i3.105 |url=}}</ref><ref name="pmid24834141">{{cite journal |vauthors=Napier KJ, Scheerer M, Misra S |title=Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities |journal=World J Gastrointest Oncol |volume=6 |issue=5 |pages=112–20 |year=2014 |pmid=24834141 |pmc=4021327 |doi=10.4251/wjgo.v6.i5.112 |url=}}</ref><ref name="pmid28943381">{{cite journal |vauthors=Matsuura H |title=Diffuse Esophageal Spasm: Corkscrew Esophagus |journal=Am. J. Med. |volume= |issue= |pages= |year=2017 |pmid=28943381 |doi=10.1016/j.amjmed.2017.08.041 |url=}}</ref><ref name="pmid1736462">{{cite journal |vauthors=Lassen JF, Jensen TM |title=[Corkscrew esophagus] |language=Danish |journal=Ugeskr. Laeg. |volume=154 |issue=5 |pages=277–80 |year=1992 |pmid=1736462 |doi= |url=}}</ref><ref name="pmid17227515">{{cite journal |vauthors=Ruigómez A, García Rodríguez LA, Wallander MA, Johansson S, Eklund S |title=Esophageal stricture: incidence, treatment patterns, and recurrence rate |journal=Am. J. Gastroenterol. |volume=101 |issue=12 |pages=2685–92 |year=2006 |pmid=17227515 |doi=10.1111/j.1572-0241.2006.00828.x |url=}}</ref><ref name="pmid25013392">{{cite journal |vauthors=Shami VM |title=Endoscopic management of esophageal strictures |journal=Gastroenterol Hepatol (N Y) |volume=10 |issue=6 |pages=389–91 |year=2014 |pmid=25013392 |pmc=4080876 |doi= |url=}}</ref><ref name="pmid11753173">{{cite journal |vauthors=López Rodríguez MJ, Robledo Andrés P, Amarilla Jiménez A, Roncero Maíllo M, López Lafuente A, Arroyo Carrera I |title=Sideropenic dysphagia in an adolescent |journal=J. Pediatr. Gastroenterol. Nutr. |volume=34 |issue=1 |pages=87–90 |year=2002 |pmid=11753173 |doi= |url=}}</ref><ref name="pmid4449772">{{cite journal |vauthors=Chisholm M |title=The association between webs, iron and post-cricoid carcinoma |journal=Postgrad Med J |volume=50 |issue=582 |pages=215–9 |year=1974 |pmid=4449772 |pmc=2495558 |doi= |url=}}</ref><ref name="pmid1192404">{{cite journal |vauthors=Larsson LG, Sandström A, Westling P |title=Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden |journal=Cancer Res. |volume=35 |issue=11 Pt. 2 |pages=3308–16 |year=1975 |pmid=1192404 |doi= |url=}}</ref>
{| class="wikitable"
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Signs and Symptoms
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Barium esophagogram
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Endoscopy
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other imaging and laboratory findings
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Gold Standard
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dysphagia
! align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
! align="center" style="background:#4479BA; color: #FFFFFF;" |Heartburn
! align="center" style="background:#4479BA; color: #FFFFFF;" |Other findings
|-
! align="center" style="background:#DCDCDC;" + |[[Esophageal carcinoma]]
| align="center" style="background:#F5F5F5;" + |Gradual progressive dysphasia to solid and liquid
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |±
| align="left" style="background:#F5F5F5;" + |
* [[Lymphadenopathy]]
* [[Cachexia]]
| align="left" style="background:#F5F5F5;" + |
* Irregular [[Strictures|stricture]]
* Pre-stricture [[dilatation]]
[[Image:Oesophageal-squamous-cell-carcinoma-2.jpg|center|200px|thumb|Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f]]
| align="left" style="background:#F5F5F5;" + |
* [[Esophageal]] obstruction
* Staging of disease
<div style="width:350px">{{#ev:youtube|5ucSlgqGAno}}</div>
| align="left" style="background:#F5F5F5;" + |
* [[CT]] and [[PET scan]] for staging of the disease
| align="left" style="background:#F5F5F5;" + |
* [[Biopsy]]
|-
! align="center" style="background:#DCDCDC;" + |[[Plummer-Vinson syndrome]]
| align="center" style="background:#F5F5F5;" + |Gradual non-progressive dysphagia to solids
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + | -
| align="left" style="background:#F5F5F5;" + |
* [[Glossitis]]
* [[Koilonychia]]
*[[Weakness]]
*Pale color of the skin
*Cold intolerance
*Reduced resistance to infection
*Altered behavior
*Craving for for unusual items (such as ice or cold vegetables)
| align="left" style="background:#F5F5F5;" + |
* Thin projections on the anterior [[esophageal]] wall
* Multiple upper [[Esophageal stricture|esophageal constrictions]]
[[Image:Plummer-vinson-syndrome.jpg|center|200px|thumb|Barium esophagogram (Source: Case courtesy of Dr Hani Salam, Radiopaedia.org, rID: 14029)]]
| align="left" style="background:#F5F5F5;" + |
* Direct visualization of [[esophageal webs]]
* Superior to [[esophagogram]]
<div style="width:350px">{{#ev:youtube|HFfsTgsB6Pg}}</div>
| align="left" style="background:#F5F5F5;" + |
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings
* [[Iron deficiency anemia]]
| align="left" style="background:#F5F5F5;" + |Triad of
* [[Iron deficiency anemia]]
* [[Esophageal webs]]
* [[Glossitis]]
|-
! align="center" style="background:#DCDCDC;" + |[[Esophageal stricture]]
| align="center" style="background:#F5F5F5;" + |Sudden onset and gradual progressive dysphasia to solids
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |±
| align="left" style="background:#F5F5F5;" + |
* [[Odynophagia]]
* [[Cough]]
* [[Chest pain]]
| align="left" style="background:#F5F5F5;" + |
*Sacculations
*Fixed transverse folds
*[[Esophageal]] intramural pseudodiverticula   
[[Image:Benign-oesophageal-stricture.jpg|center|200px|thumb|Case courtesy of Dr Ahmed Abd Rabou, Radiopaedia.org, rID: 23008]]
| align="left" style="background:#F5F5F5;" + |
* [[Mucosal]] edema
* Circumferential thickening in [[Gastroesophageal reflux disease|GERD]]
* Pale [[mucosa]] with white [[exudate]] in lymphocytic esophagitis
* [[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]] ingestion
<div style="width:350px">{{#ev:youtube|vax5E-jMnQ}}</div>
| align="left" style="background:#F5F5F5;" + |
* [[Manometry]] may show dysmotility
* [[CT scan]] for staging [[malignant]] [[strictures]]
| align="left" style="background:#F5F5F5;" + |
* [[Esophagogram|Barium esophagogram]]
|-
! align="center" style="background:#DCDCDC;" + |[[Diffuse esophageal spasm]]
| align="center" style="background:#F5F5F5;" + |Sudden non-progressive dysphagia to solid and liquid
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Chest pain]]
| align="left" style="background:#F5F5F5;" + |
* Nonperistaltic and nonpropulsive contractions
* Corkscrew or rosary bead esophagus
[[Image:DES radio.png|center|200px|thumb|Barium swallow appearance of DES<br>Source:By Nevit Dilmen [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)]]
| align="left" style="background:#F5F5F5;" + |
* Inconclusive
<div style="width:350px">{{#ev:youtube|2ipA34iMA3c}}</div>
| align="left" style="background:#F5F5F5;" + |
*[[Manometry]] shows high-amplitude [[esophageal]] contractions
*[[CT scan]] may show [[hypertrophy]] of esophageal muscles
| align="left" style="background:#F5F5F5;" + |
* [[Manometry]]
|-
! align="center" style="background:#DCDCDC;" + |[[Achalasia]]
| align="center" style="background:#F5F5F5;" + |Gradual non-progressive dysphagia to solid and liquid
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + | -
| align="left" style="background:#F5F5F5;" + |
* [[Dyspnea]]
* [[Regurgitation]] of undigested food
* [[Chest pain]]
* [[Cough]]
| align="left" style="background:#F5F5F5;" + |
* "Bird's beak" or "rat tail" appearance
* Dilated esophageal body
* Air fluid level (absent [[peristalsis]])
* Absence of an intragastric air bubble
[[Image:Achalasia-2.jpg|center|200px|thumb|Case courtesy of Dr Mario Umana, Radiopaedia.org, rID: 38071]]
| align="left" style="background:#F5F5F5;" + |
* Dilated [[esophagus]]
* Residual food fragments
* Normal [[mucosa]]
<div style="width:350px">{{#ev:youtube|ydLcskQzEjM}}</div>
| align="left" style="background:#F5F5F5;" + |
* Residual pressure of [[Lower esophageal sphincter|LES]] > 10 mmHg
* Incomplete relaxation of the [[Lower esophageal sphincter|LES]]
* Increased resting tone of [[Lower esophageal sphincter|LES]]
* Aperistalsis
| align="left" style="background:#F5F5F5;" + |
* History of [[dysphagia]] with positive [[endoscopy]] and [[manometry]]
|-
! align="center" style="background:#DCDCDC;" + |[[Systemic sclerosis]]
| align="center" style="background:#F5F5F5;" + |Gradual progressive dysphasia to solid and liquid
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Muscle pain|Muscle]] and [[Arthralgia|joint pain]]
* [[Raynaud's phenomenon]]
* [[Skin changes]]
| align="left" style="background:#F5F5F5;" + |
* Dysmotility
* Patulous [[esophagus]]
| align="left" style="background:#F5F5F5;" + |
* [[Mucosal]] damage
* [[Peptic]] stricture (advanced cases)
| align="left" style="background:#F5F5F5;" + |Positive serology for
* [[Antinuclear antibodies]]
* [[Rheumatoid factor]]
* [[Creatine kinase]]
* [[ESR]]
| align="left" style="background:#F5F5F5;" + |
* [[Skin biopsy]]
|-
! align="center" style="background:#DCDCDC;" + |[[Zenker's diverticulum]]
| align="center" style="background:#F5F5F5;" + |Gradual dysphasia to solid
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + | -
| align="left" style="background:#F5F5F5;" + |
* Food [[regurgitation]]
* [[Halitosis]]
* [[Coughing|Cough]]
* [[Hoarseness]]
| align="left" style="background:#F5F5F5;" + |
* Thin projections on [[esophageal]] wall over [[Killian's dehiscence|Killian's triangle]]
| align="left" style="background:#F5F5F5;" + |
* Outpouching of posterior [[pharyngeal]] wall
* Exclude the presence of [[Squamous cell carcinoma|SCC]]
<div style="width:350px">{{#ev:youtube|FdEruFsNdVA}}</div> 
| align="left" style="background:#F5F5F5;" + |
* [[CT]] & [[MRI]] shows out-pouching over the posterior esophagus in the Killian's triangle
| align="left" style="background:#F5F5F5;" + |
* Barium [[Esophagogram|esophagography]]
|-
! align="center" style="background:#DCDCDC;" + |[[Stroke]] ([[Cerebral hemorrhage]])
| align="center" style="background:#F5F5F5;" + |Sudden progressive dysphasia to solid and liquid
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |±
| align="left" style="background:#F5F5F5;" + |
* [[Dysarthria]]
* Limb [[weakness]]
* [[Fatigue]]
| align="left" style="background:#F5F5F5;" + |
* Pooling of [[Contrast medium|contrast]] in the [[pharynx]]
* [[Aspiration]] of [[barium]] [[Contrast medium|contrast]] into the [[airway]]
| align="left" style="background:#F5F5F5;" + |
* Reduced opening of [[upper esophageal sphincter]]
* Reduced [[larynx]] elevation
| align="left" style="background:#F5F5F5;" + |
* [[CT]] without [[contrast]] shows acute [[hemorrhage]] as a hyperattenuating [[clot]]
| align="left" style="background:#F5F5F5;" + |
* [[CT]] without [[Contrast medium|contrast]]
|-
! align="center" style="background:#DCDCDC;" + |Motor disorders ([[Myasthenia gravis]])
| align="center" style="background:#F5F5F5;" + |Gradual progressive dysphasia to solid and liquid
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* [[Ptosis]]
* [[Diplopia]]
* [[Fatigue]]
| align="left" style="background:#F5F5F5;" + |
* Stasis in [[pharynx]] and pooling in pharyngeal recesses
| align="left" style="background:#F5F5F5;" + |
* [[Velopharyngeal insufficiency]]
* Delayed [[swallowing]] function
| align="left" style="background:#F5F5F5;" + |
* CT may show anterior [[mediastinal]] mass ([[thymoma]])
* Positive tensilon test
| align="left" style="background:#F5F5F5;" + |
* Anti–acetylcholine receptor antibody test
|-
! align="center" style="background:#DCDCDC;" + |[[GERD]]
| align="center" style="background:#F5F5F5;" + |Sudden onset gradual progressive dysphasia to solid
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Cough]]
* [[Hoarseness]]
* Retrosternal burning [[chest pain]]
| align="left" style="background:#F5F5F5;" + |
* Free acid reflux
* [[Esophagitis]] with scarring
* [[Strictures]]
* [[Barrett's oesophagus]]
| align="left" style="background:#F5F5F5;" + |
* [[Erythema]], erosions and [[ulceration]]
* [[Barrett's esophagus]]
| align="left" style="background:#F5F5F5;" + |
* Esophageal [[manometry]] may show decreased tone of [[Lower esophageal sphincter|LES]]
| align="left" style="background:#F5F5F5;" + |
* 24 hour [[esophageal]] pH monitoring
|-
! align="center" style="background:#DCDCDC;" + |[[Esophageal web]]
| align="center" style="background:#F5F5F5;" + |Gradual progressive dysphasia to solid and/or liquid
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + |±
| align="left" style="background:#F5F5F5;" + |
* Findings of the underlying cause such as [[iron deficiency anemia]] or [[bullous pemphigoid]]
| align="left" style="background:#F5F5F5;" + |
* Symmetrical narrowing of the [[esophagus]]
| align="left" style="background:#F5F5F5;" + |
* Smooth membrane not encircling the whole [[Lumen (anatomy)|lumen]]
| align="left" style="background:#F5F5F5;" + |
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings
| align="left" style="background:#F5F5F5;" + |
* Barium [[esophagogram]]
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}


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Latest revision as of 21:40, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]Hadeel Maksoud M.D.[3]

Overview

Esophageal cancer must be differentiated from gastroesophageal reflux disease (GERD), Barrett's esophagus, esophageal achalasia, gastritis, gastric ulcer, and stomach cancer.

Differentiating Esophageal cancer from other Diseases

Approach to dysphasia

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Dysphagia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Oropharyngeal dysphagia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Esophageal dysphagia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Solids only
 
 
 
 
 
 
 
 
 
 
 
 
Solids and Liquids
 
 
 
 
 
 
 
 
 
 
Solids only
 
 
 
 
 
 
 
 
 
Solids and Liquids
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑Zenker's diverticulum
❑Neoplasm
❑Webs
 
 
 
 
 
 
 
 
 
Neurogenic
 
 
 
Myogenic
 
 
 
 
 
 
 
Pain
 
 
 
 
 
 
 
 
 
❑Achalasia
❑Scleroderma
❑DES
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑Myasthenia gravis
❑Connective tissue disorder
❑Myotonic dystrophy
 
 
 
 
No
 
 
 
 
Yes
 
 
 
 
 
❑Heart burn
 
 
 
 
 
 
 
Barium swallow
 
 
 
 
 
 
 
 
 
Mental status
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑Pill esophagitis
❑Caustic injury
❑Chemotherapy
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Impaired
 
 
 
Normal
 
 
 
 
Non progressive
 
 
 
Progressive
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sac
 
 
Webs
 
 
Mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑Scleroderma
 
 
 
❑Achalasia
❑DES
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑Stroke
 
 
 
❑ALS
❑Parkinsonism
 
 
 
 
❑Rings
❑Webs
 
 
 
❑Strictures
❑Cancer
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑Zenker's diverticulum
 
 
❑Plummer-Vinson syndrome
 
 
❑Carcinoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chest pain and manometry
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Barium swallow
 
 
 
Weight loss
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Increase LES pressure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑Rings
 
 
 
❑Webs
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rapid
 
 
 
Slow
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑Achalasia
 
 
 
❑DES
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑Esophageal cancer
 
 
 
❑Strictures/GERD
 
 
 
 
 
 

Differentiating Esophageal cancer from other Diseases

Disease Signs and Symptoms Barium esophagogram Endoscopy Other imaging and laboratory findings Gold Standard
Dysphagia Weight loss Heartburn Other findings
Esophageal carcinoma Gradual progressive dysphasia to solid and liquid + ±
Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f
{{#ev:youtube|5ucSlgqGAno}}
Plummer-Vinson syndrome Gradual non-progressive dysphagia to solids ± -
  • Glossitis
  • Koilonychia
  • Weakness
  • Pale color of the skin
  • Cold intolerance
  • Reduced resistance to infection
  • Altered behavior
  • Craving for for unusual items (such as ice or cold vegetables)
Barium esophagogram (Source: Case courtesy of Dr Hani Salam, Radiopaedia.org, rID: 14029)
{{#ev:youtube|HFfsTgsB6Pg}}
Triad of
Esophageal stricture Sudden onset and gradual progressive dysphasia to solids ± ±
  • Sacculations
  • Fixed transverse folds
  • Esophageal intramural pseudodiverticula   
Case courtesy of Dr Ahmed Abd Rabou, Radiopaedia.org, rID: 23008
{{#ev:youtube|vax5E-jMnQ}}
Diffuse esophageal spasm Sudden non-progressive dysphagia to solid and liquid + +
  • Nonperistaltic and nonpropulsive contractions
  • Corkscrew or rosary bead esophagus
Barium swallow appearance of DES
Source:By Nevit Dilmen [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)
  • Inconclusive
{{#ev:youtube|2ipA34iMA3c}}
Achalasia Gradual non-progressive dysphagia to solid and liquid ± -
  • "Bird's beak" or "rat tail" appearance
  • Dilated esophageal body
  • Air fluid level (absent peristalsis)
  • Absence of an intragastric air bubble
Case courtesy of Dr Mario Umana, Radiopaedia.org, rID: 38071
{{#ev:youtube|ydLcskQzEjM}}
  • Residual pressure of LES > 10 mmHg
  • Incomplete relaxation of the LES
  • Increased resting tone of LES
  • Aperistalsis
Systemic sclerosis Gradual progressive dysphasia to solid and liquid ± + Positive serology for
Zenker's diverticulum Gradual dysphasia to solid ± -
  • Outpouching of posterior pharyngeal wall
  • Exclude the presence of SCC
{{#ev:youtube|FdEruFsNdVA}}
 
  • CT & MRI shows out-pouching over the posterior esophagus in the Killian's triangle
Stroke (Cerebral hemorrhage) Sudden progressive dysphasia to solid and liquid + ±
Motor disorders (Myasthenia gravis) Gradual progressive dysphasia to solid and liquid ±
  • Stasis in pharynx and pooling in pharyngeal recesses
  • Anti–acetylcholine receptor antibody test
GERD Sudden onset gradual progressive dysphasia to solid ± +
Esophageal web Gradual progressive dysphasia to solid and/or liquid - ±
  • Smooth membrane not encircling the whole lumen

References

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