Clinical Manifestations
Dysphagia is the most frequent and important symptom of esophageal carcinoma (see Chapter 38). This symptom usually begins with difficulty in swallowing solids and then progresses steadily over six to nine months to involve liquids as well. Anorexia and weight loss commonly occur simultaneously. Regurgitation and aspiration may lead to coughing after swallowing fluids or to recurrent episodes of bronchopneumonia.
Substernal pain usually follows dysphagia and most frequently reflects extension of the tumor into mediastinal structures. These tumors rarely bleed briskly (about 5 per cent) but may result in slow, steady blood loss. With extension of the tumor the recurrent laryngeal nerve may be involved, resulting in hoarseness. Nail clubbing may occur, and very rarely paraneoplastic endocrine abnormalities (hypercalcemia, Cushing’s syndrome) have been described.