Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Esophageal Cancer Esophageal Infections and Inflammation 551

differential diagnosis

■Benign vs malignant (biopsy required)

management

What to Do First

■stage extent of disease:

■TNM based

■CT scans of chest and abdomen to rule out distant disease

■endoscopic ultrasound most accurate to determine depth of tumor

and nodal involvement

General Measures

■assess comorbities and suitability of patient for surgery

specific therapy

■surgery

➣curative if not metastatic

■endoscopy

➣curative for early superficial disease

➣palliative for obstruction by stent placement

■chemoradiotherapy

➣unclear if useful as neoadjuvant

follow-up

■No specific protocol: recurrence is usually not treatable

■Regular blood tests q 3 months, and CT scans q 12 months

complications and prognosis

■Median survival

➣Stage I – 63 months

➣Stage II – 26 months

➣Stage IIB – 13 months

➣Stage III – 10 months

➣Stage IV–9months

Esophageal Infections and Inflammation...................

LAUREN B. GERSON, MD, MSc

history & physical

History

■immunodeficiency states, AIDS, solid organ transplantation, dia-

betes mellitus, recent or current antibiotic usage, disorders of