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Esophageal CancerEsophageal Cancer

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Esophageal CancerEsophageal Cancer One of the most lethal tumorsOne of the most lethal tumors Starts at the lining and spreads Starts at the lining and spreads

outwardoutward Squamous cell carcinomaSquamous cell carcinoma AdenocarcinomaAdenocarcinoma

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EsophagealEsophageal CancerCancer United States: 4 per 100,000 malesUnited States: 4 per 100,000 males

Twice as high in males as in femalesTwice as high in males as in females

Northern China: 130 per 100,000 Northern China: 130 per 100,000 malesmales

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Risk FactorsRisk Factors Tobacco useTobacco use Heavy alcohol useHeavy alcohol use Older ageOlder age Being maleBeing male Being African-AmericanBeing African-American Having Barrett’s esophagusHaving Barrett’s esophagus

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SymptomsSymptoms Early stages often has no Early stages often has no

symptomssymptoms Painful or difficult swallowingPainful or difficult swallowing Weight lossWeight loss Pain behind the breastbonePain behind the breastbone Hoarseness and coughHoarseness and cough Indigestion and heartburnIndigestion and heartburn

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TestsTests Chest x-rayChest x-ray Barium swallowBarium swallow

› EsophagramEsophagram EsophagoscopyEsophagoscopy BiopsyBiopsy

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Treatment/PrognosisTreatment/Prognosis Depend onDepend on

› stage of cancerstage of cancer› size of tumorsize of tumor› patient’s general healthpatient’s general health

When found very early, better When found very early, better chance of recoverychance of recovery

Often in advanced stage at Often in advanced stage at diagnosisdiagnosis

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Staging ProcessStaging Process BronchoscopyBronchoscopy Chest x-rayChest x-ray LaryngoscopyLaryngoscopy CT scanCT scan ThoracoscopyThoracoscopy LaparoscopyLaparoscopy PET scanPET scan

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TreatmentTreatment SurgerySurgery

Chemotherapy plus radiation Chemotherapy plus radiation therapy with or without surgerytherapy with or without surgery

External or internal radiation as External or internal radiation as palliative therapypalliative therapy

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Untreated HeartburnUntreated Heartburn EsophagitisEsophagitis Esophageal bleeding & ulcersEsophageal bleeding & ulcers Barrett’s esophagusBarrett’s esophagus StricturesStrictures Esophageal cancerEsophageal cancer

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Barrett’s EsophagusBarrett’s Esophagus Can lead to cancer!!Can lead to cancer!! People with regular or daily People with regular or daily

heartburn for more than 5 years may heartburn for more than 5 years may be at riskbe at risk

EndoscopyEndoscopy Proton pump inhibitor medicationsProton pump inhibitor medications

› Nexium Protonix PrevacidNexium Protonix Prevacid› Prilosec AciphexPrilosec Aciphex

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Barrett’s EsophagusBarrett’s Esophagus Because of the cancer risk, people Because of the cancer risk, people with Barrett’s esophagus are with Barrett’s esophagus are surveyed for esophageal cancer surveyed for esophageal cancer regularlyregularly

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StricturesStrictures

Damaged lining of the esophagus Damaged lining of the esophagus

becomes scarred, causing becomes scarred, causing

narrowing of the esophagusnarrowing of the esophagus

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Hiatal HerniaHiatal Hernia A portion of the stomach pushes A portion of the stomach pushes

thru a tear-shaped hole where the thru a tear-shaped hole where the esophagus and stomach joinesophagus and stomach join

Most common cause is an increase Most common cause is an increase pressure on the abdominal cavitypressure on the abdominal cavity

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Symptoms of Hiatal Symptoms of Hiatal HerniaHernia NoneNone HeartburnHeartburn Bitter or sour taste in back of the Bitter or sour taste in back of the

throatthroat Bloating and belchingBloating and belching Discomfort or pain in stomach or Discomfort or pain in stomach or

esophagusesophagus VomitingVomiting

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Lifestyle ChangesLifestyle Changes WeightWeight Portion sizePortion size Wait 3 to 4 hours before lying Wait 3 to 4 hours before lying

downdown Elevate head of bed by 6 inchesElevate head of bed by 6 inches No smokingNo smoking Over-the-counter medicationsOver-the-counter medications

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Foods to AvoidFoods to Avoid OnionsOnions ChocolateChocolate PeppermintPeppermint High-fat foodsHigh-fat foods AlcoholAlcohol Caffeinated beverages and foodsCaffeinated beverages and foods

› coffee, tea, colas, chocolatecoffee, tea, colas, chocolate