Malignant Neoplasm Of Esophagus Differential Diagnosis Table

Malignant Neoplasm Of Esophagus Differential Diagnosis Table:

The esophagus is a muscular tube that extends from the pharynx to the stomach and serves for the passage of food entering through the mouth. It crosses the neck and thorax to reach the abdomen in front of the spinal column and is in close relation with different structures such as: heart, diaphragm, aorta, recurrent nerve, left larynx. The main types of esophagus cancer are: squamous, which is flat-cell derived, and adenocarcinoma, which is granular cell derived.

Esophageal cancer is more common in men than women and the usual age of presentation is between 55 and 70 years of age.
Depending on the histopathology of the cancer, the risk factors associated with the development of squamous cell carcinoma are: tobacco, alcohol, diet, ingestion of caustics, Barrett’s esophagus, while risk factors associated with adenocarcinoma are: GERD, obesity, Helicobacter pylori infection.

The symptoms associated with Malignant neoplasm of esophagus are: dysphagia, dysphonia, hoarseness, hiccups, bleeding, weight loss, respiratory symptoms.
In my experience, there was a patient who was diagnosed randomly by a routine endoscopy and colonoscopy. He was a 72-year-old obese male with a history of chronic gastroesophageal reflux, and he was diagnosed with distal esophageal adenocarcinoma. Sadly, at that time, his last endoscopy and colonoscopy was more than 2 years ago due to the COVID pandemic.

How to Distinguish Malignant Neoplasm of Esophagus from Other Diseases

Distinguish GERD from Malignant Neoplasm of Esophagus – Diagnosis

Occurs when the lower esophageal sphincter relaxes when it should not.
⦁ GERD, unlike Malignant Neoplasm of Esophagus, presents heartburn and regurgitation.
⦁ GERD, unlike Malignant Neoplasm of Esophagus, does not present unintentional weight loss and difficulty swallowing.
⦁ GERD treatment, unlike Malignant Neoplasm of Esophagus, consists of dietary changes, losing weight, and eating at least 2 hours before bedtime.

Distinguish Gastritis from Malignant Neoplasm of Esophagus – Diagnosis

It is the inflammation of the stomach lining.

• The most common cause of Gastritis is Helicobacter Pylori infection as opposed to Malignant Neoplasm of Esophagus which is multifactorial.
• Gastritis, unlike Malignant Neoplasm of Esophagus, presents nausea and vomiting.
• The diagnosis of Gastritis is made by blood tests, gastroscopy, and stool analysis while Malignant Neoplasm of Esophagus is made by a complete blood count test, endoscopy, thorax and abdomen CT, respiratory function tests, bronchoscopy, as well as a complete physical examination and a complete medical history.
• Gastritis treatment, unlike Malignant Neoplasm of Esophagus, consists of proton pump inhibitors and antibiotics if it is due to Helicobacter Pylori infection.

Distinguish Esophageal Ulcer from Malignant Neoplasm of Esophagus – Diagnosis

It is a painful sore located in the lining of the lower esophagus.

• Esophageal ulcer, unlike Malignant Neoplasm of Esophagus, presents: chest pain, indigestion, nausea, vomiting, pain on swallowing, dry cough, and sour taste in the mouth.
• The most common cause of Esophageal ulcer is Helicobacter Pylori infection or by the use of NSAIDs as opposed to Malignant Neoplasm of Esophagus which is multifactorial.
• Esophageal ulcer treatment, unlike Malignant Neoplasm of Esophagus, consists of proton pump inhibitors and antibiotics if it is due to Helicobacter Pylori infection.

Distinguish Esophageal Stricture from Malignant Neoplasm of Esophagus – Diagnosis

It is defined as the narrowing of the esophagus due to a multifactorial cause.

• Esophageal stricture, unlike Malignant Neoplasm of Esophagus, may be caused by esophageal varices, misuse of endoscope, gastroesophageal reflux, consumption of toxic substances, or prolonged use of nasogastric tube.
• Esophageal stricture diagnosis is made by barium swallow test, esophageal manometry, and endoscopy while Malignant Neoplasm of Esophagus is made by a complete blood count test, endoscopy, thorax and abdomen CT, respiratory function tests, bronchoscopy, as well as a complete physical examination and a complete medical history.
• Esophageal stricture treatment, unlike Malignant Neoplasm of Esophagus, consists of surgical dilatation of the esophagus.

Distinguish Barrett’s Esophagus from Malignant Neoplasm of Esophagus – Diagnosis

Barrett’s Esophagus is a premalignant disorder in which there is a change in the epithelium of the lining of the esophagus due to gastric acid.

• Barrett’s Esophagus is a premalignant lesion while Malignant Neoplasm of Esophagus is already a cancerous condition.
• Barrett’s Esophagus, unlike Malignant Neoplasm of Esophagus, presents chest pain and heartburn.

Distinguish Esophageal Spasm from Malignant Neoplasm of Esophagus – Diagnosis

Esophageal spasms are painful irregular uncoordinated contractions.

• Esophageal spasms, unlike Malignant Neoplasm of Esophagus, are due to an interruption of nerve activity that coordinates swallowing.
• Esophageal spasms, unlike Malignant Neoplasm of Esophagus, present difficulty or inability to swallow food or liquids, pain when swallowing, feeling that the food gets stuck in the chest, and heartburn.

Distinguish Achalasia from Malignant Neoplasm of Esophagus – Diagnosis

It is a disorder of esophageal motility.

• Achalasia, unlike Malignant Neoplasm of Esophagus, is of neurogenic origin.
• Achalasia is more prevalent between 20 and 60 years of age while Malignant Neoplasm of Esophagus usual age of presentation is between 55 and 70 years of age.
• Achalasia, unlike Malignant Neoplasm of Esophagus, presents night regurgitations and cough.

Distinguish Stomach Cancer from Malignant Neoplasm of Esophagus – Diagnosis

It is a cancer that originates from the cells of the gastric epithelium.

• Stomach cancer is more prevalent in patients over 60 years of age while Malignant Neoplasm of Esophagus usual age of presentation is between 55 and 70 years of age.
• Stomach cancer, unlike Malignant Neoplasm of Esophagus, presents abdominal pain, nausea, vomiting, and fatigue.

Common Red Flags with Malignant Neoplasm of Esophagus

The diagnostic studies used to detect this disease are: a complete blood count test, endoscopy, thorax and abdomen CT, respiratory function tests, bronchoscopy, as well as a complete physical examination and a complete medical history.
There are 3 treatment options: surgery (by esophagectomy) radiation therapy (is used with curative intent or palliative intent), and chemotherapy (can be used as a single treatment or as a part of a multidisciplinary treatment combined with surgery or radiation therapy).
Prognosis is poor since after diagnosis with symptomatic patients the survival rate is five years, for this reason, it is very important to perform periodic follow-ups to diagnose relapses at an early stage.
Complications include: chronic pain, esophageal obstruction, and bleeding.