Case history
Case history #1
A 55-year-old man presents with severe dysphagia to solids and worsening dysphagia to liquids. His social history is significant for 40 pack-year cigarette smoking and a 6-pack of beer per day. He has lost over 10% of his body weight and currently is nourished only by milkshake supplements. He complains of some mild odynophagia and is constantly coughing up mucus secretions.
Case history #2
An otherwise healthy 45-year-old male executive complains of heartburn. He has tried over-the-counter medications with no relief. He took a course of proton pump inhibitors for 6 weeks, but still has heartburn. He has no weight loss or dysphagia.
Other presentations
Oesophageal cancer often presents in an insidious and non-specific manner, with indigestion, retrosternal discomfort, and dysphagia being the leading complaints. Often patients present late because they have compensated for dysphagia by eating softer foods or chewing their food more thoroughly. Patients may develop respiratory sequelae, primarily from aspiration but also from other causes, such as direct invasion of tumour into the tracheobronchial tree (usually involving the left main stem bronchus). Symptoms may include cough, dyspnoea, or pleuritic pain. Hoarseness can result from direct involvement of the recurrent laryngeal nerve.
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