58 y/o male presents with a 5-day history of sudden onset of dysphagia to both solids and liquids. He has no previous history of dysphagia.

The prevalence of adenocarcinoma of the esophagus in the United States has been rapidly increasing in recent years. This is thought to be in part due to the increasing incidence of Barrett's metaplasia. Affected patients typically present in their middle sixties with progressive dysphagia, at first to solids and then to liquids. As a result, weight loss and weakness often occur. Unfortunately, esophageal cancer usually invades the submucosa before extending into the lumen, thus prolonging symptoms.1 Patients with adenocarcinoma usually have advanced tumors at presentation, thus making surgical resection difficult and having an overall 5-year survival rate below 10%.2 As long as the patient is a suitable candidate for major surgery and there are no distant organ metastases, the primary tumor should be resected, if possible. Because adenocarcinomas are typically in the distal third of the esophagus, they are resected transthoracically or transhiatally. A colonic interposition, rather than gastric pull-up, may be performed in order to prevent later development of second cancer from Barrett's mucosa.3 Unfortunately, if surgery is not an option, esophageal adenocarcinoma is relatively radioinsensitive, and radiation therapy is only palliative.