ESOPHAGEAL CANCER

Adenocarcinoma of the Esophagus; Squamous cell carcinoma of the Esophagus

Esophageal Cancer originates from the lining of the esophagus and presents as either squamous cell carcinoma (cancer that begins in flat cells lining the esophagus) or adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). In general, squamous cell carcinoma is usually found in the upper esophagus while adenocarcinoma is located in the lower part of the esophagus and may be related to reflux disease and a condition termed Barrett's esophagus. Esophageal cancer may spread throughout the esophagus and may also extend beyond the edges of the primary tumor (distant metastases). Esophageal Cancer may spread throughout the esophagus and may extend beyond the edges of the primary tumor (distant metastases).

Diagnostic testing: Definitive diagnosis is by esophagoscopy with visualization of the cancer and biopsy. Additional testing includes:

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  Barium swallow (esophagram);

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  CT scan of the chest, abdomen, and pelvis;

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  PET scan; and

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  Bone scan.

Physical findings: Individuals with esophageal cancer may present with:

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  Dysphagia (difficulty swallowing);

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  Weight loss;

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  GI bleed;

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  Epigastric or retrosternal area pain; and

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  Persistent cough.

ICD-9: 150.9

The prognosis for esophageal cancer is not good regardless of the treatment employed. When esophageal cancer is found very early, there is a better chance of recovery. Esophageal cancer is often in an advanced stage when it is diagnosed. At later stages, esophageal cancer can be treated but rarely can be cured.

Historically, treatment of esophageal cancer has been surgery. Recent multimodality therapy with radiation, chemotherapy and surgery has begun to play a major role in treatment.

Suggested MER for Evaluation:

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  Clinical history and examination that describes the diagnostic features of the impairment;

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  Pathology report from esophagoscopy; and

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  Imaging reports.

Suggested Listings for Evaluation:

REMARKS

Esophageal Cancer meets the criteria in 13.16 A.