Esophageal Cancer Symptoms: From Early Dysphagia to Advanced Disease

Esophageal cancer symptoms evolve with tumor growth and local invasion. Early detection is rare; most present with advanced disease.

Progressive Symptom Pattern

1. Dysphagia (universal, progressive): Solids → soft foods → liquids. Weight loss correlates with severity.
2. Odynophagia: Painful swallowing (tumor ulceration, invasion).
3. Weight loss: 10–20% body weight common at diagnosis (dysphagia + cancer cachexia).
4. Regurgitation: Undigested food, saliva; aspiration risk.
5. Chest/back pain: Mediastinal invasion (trachea, aorta, vertebra).
6. Hoarseness: Recurrent laryngeal nerve palsy (left > right).
7. Chronic cough: Tracheoesophageal fistula, aspiration, airway compression.
8. Hiccups: Phrenic nerve/diaphragm irritation.
9. Melena/hematemesis: Tumor erosion into vessels.
10. Supraclavicular nodes (Virchow's node): Left-sided = gastric/esophageal spread.

Histology-Specific Patterns

• Adenocarcinoma (distal esophagus/GEJ): Associated with Barrett's, obesity, GERD. Rising incidence.
• Squamous cell carcinoma (mid/upper): Smoking, alcohol, hot beverages, achalasia, tylosis.

Alarm Features Requiring Urgent Endoscopy

• New-onset dysphagia >2 weeks (age >40 or risk factors)
• Unintentional weight loss
• Odynophagia
• GI bleeding (iron deficiency anemia)
• Persistent reflux unresponsive to PPI

Staging Workup

Endoscopy + biopsy → EUS (T/N staging) → CT chest/abdomen/pelvis → PET-CT (metastasis) → laparoscopy (selected).

5-year survival: Localized ~47%, Regional ~25%, Distant ~5%. Early detection (T1a) → endoscopic resection curative.