Esophageal Cancer Overview
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Questions and Answers

What is the most common subtype of colorectal cancer?

  • Adenocarcinoma (correct)
  • Squamous cell carcinoma
  • Neuroendocrine tumor
  • Lymphoma

    • What percentage of colorectal cancer patients will experience relapse within 3 years of surgery, if they have not undergone presurgical CEA?

  • 70%
  • 80% (correct)
  • 50%
  • 60%

    • Which of the following is NOT a risk factor for colorectal cancer?

  • HNPCC/Lynch syndrome
  • Anal intercourse (correct)
  • Blood group A
  • Partial gastrectomy

    • What is the most effective treatment for Stage I and II rectal cancer?

    <p>Surgery (C)</p> Signup and view all the answers

    Which of the following presentation symptoms is more characteristic of rectal cancer than colon cancer?

    <p>Bleeding from the anus (C)</p> Signup and view all the answers

    What is the most common location for colorectal cancer within the large intestine?

    <p>Left colon and sigmoid (C)</p> Signup and view all the answers

    Which of the following is a risk factor for anal cancer?

    <p>HPV infection (B)</p> Signup and view all the answers

    Which of the following is a characteristic of left-sided colorectal cancer?

    <p>Obstruction (C)</p> Signup and view all the answers

    What is the primary treatment for Stage IV rectal cancer?

    <p>Surgery and Chemotherapy (D)</p> Signup and view all the answers

    What is the recommended frequency of screening colonoscopies for individuals with higher risk factors for colorectal cancer?

    <p>Every 10 years (A)</p> Signup and view all the answers

    Which of the following is NOT a risk factor for hepatocellular carcinoma?

    <p>Primary biliary cholangitis (B)</p> Signup and view all the answers

    What is the most common site of intrahepatic metastasis in liver cancer?

    <p>Portal vein (C)</p> Signup and view all the answers

    Which of the following is a specific lymph node associated with abdominal cancer?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is a paraneoplastic syndrome associated with intestinal adenocarcinoma?

    <p>Both A and B (D)</p> Signup and view all the answers

    Which of the following breast cancer subtypes has the best prognosis?

    <p>Luminal A (C)</p> Signup and view all the answers

    Which of the following factors is NOT a major prognostic factor in breast cancer?

    <p>Age at diagnosis (B)</p> Signup and view all the answers

    What is the most common histological subtype of Luminal A breast cancer?

    <p>Invasive ductal carcinoma, no special type (NST) (C)</p> Signup and view all the answers

    Which of the following is NOT a preventive measure for breast cancer?

    <p>Regular mammograms (A)</p> Signup and view all the answers

    Which of the following is TRUE about the prognosis of metastatic breast cancer?

    <p>It depends on the site of metastasis and the subtype of breast cancer. (D)</p> Signup and view all the answers

    What is the significance of a spiculated mass on mammography?

    <p>It is highly suggestive of cancer and should be further investigated. (B)</p> Signup and view all the answers

    What is the most common origin of metastatic bone cancer?

    <p>Breast cancer (C)</p> Signup and view all the answers

    Which imaging method is considered the best choice for diagnosing soft tissue sarcomas (STS)?

    <p>MRI (A)</p> Signup and view all the answers

    In which type of environment are known risk factors for mesenchymal cancer found?

    <p>Ionizing radiation and vinyl chloride (B)</p> Signup and view all the answers

    What is the typical age of occurrence for osteosarcoma?

    <p>16 years old (D)</p> Signup and view all the answers

    What type of cancer is associated with a high risk of metastasis when the tumor size exceeds 5 cm?

    <p>Leiomyosarcoma (C)</p> Signup and view all the answers

    Which of the following risk factors is specifically associated with squamous cell carcinoma (SCC) of the esophagus?

    <p>Plummer-Vinson syndrome (C)</p> Signup and view all the answers

    In the context of esophageal cancer, what does the abbreviation 'EUS' stand for, and what is its primary purpose?

    <p>Endoscopic Ultrasound; used for staging and evaluating lymph node involvement. (D)</p> Signup and view all the answers

    Regarding the prognosis of esophageal cancer, which of the following statements is most accurate?

    <p>The size of the tumor is a significant factor, with a larger tumor size generally indicating a poorer prognosis. (A)</p> Signup and view all the answers

    A patient presents with dysphagia and weight loss. Which of the following diagnostic procedures would most likely be used to determine the presence of esophageal cancer?

    <p>Gastroscopy with biopsy (A)</p> Signup and view all the answers

    Which of the following statements accurately describes the typical location of adenocarcinoma of the esophagus?

    <p>It typically occurs in the lower third of the esophagus. (B)</p> Signup and view all the answers

    A patient undergoing treatment for esophageal cancer reports hoarseness. What is the most likely explanation for this symptom?

    <p>The tumor is putting pressure on the recurrent laryngeal nerve. (D)</p> Signup and view all the answers

    Which of the following is NOT a potential risk factor for squamous cell carcinoma (SCC) of the esophagus?

    <p>High intake of fruits and vegetables (C)</p> Signup and view all the answers

    Which of the following is a potential strategy for treating esophageal cancer that is inoperable?

    <p>Radical chemoradiotherapy (B)</p> Signup and view all the answers

    A 70-year-old patient presents with dyspnea and paralysis. Which type of cancer is most likely to be considered based on the patient's age and symptoms?

    <p>Lung cancer (D)</p> Signup and view all the answers

    Which type of molecular testing IS NOT performed routinely for colon cancer patients?

    <p>BRCA1 (C)</p> Signup and view all the answers

    Which of the following is NOT a risk factor for colon cancer?

    <p>Blood group A (C)</p> Signup and view all the answers

    A patient diagnosed with stage III colon cancer is likely to receive which treatment?

    <p>Surgery followed by chemotherapy (C)</p> Signup and view all the answers

    What is the most common site for metastasis in colon cancer?

    <p>Liver (C)</p> Signup and view all the answers

    A patient presents with multiple polyps in the colon, and a family history of colon cancer. What is the most likely diagnosis?

    <p>Familial adenomatous polyposis (FAP) (A)</p> Signup and view all the answers

    Which of the following statements is TRUE regarding the prognosis of colon cancer?

    <p>Patients diagnosed with metastatic disease have a poor prognosis. (A)</p> Signup and view all the answers

    What is the most common subtype of colon cancer?

    <p>Adenocarcinoma (C)</p> Signup and view all the answers

    Which of the following is a characteristic of FAP?

    <p>Increased risk of colon cancer at age 55 (B)</p> Signup and view all the answers

    What is the role of panitumumab in treating colon cancer?

    <p>To target KRAS/BRAF mutations (B)</p> Signup and view all the answers

    Flashcards

    Esophageal Cancer

    A rare cancer comprising 1% of all cancers, with two main types: SCC and AC.

    Squamous Cell Carcinoma (SCC)

    A subtype of esophageal cancer, often linked to risk factors like smoking and alcohol.

    Adenocarcinoma (AC)

    Another subtype of esophageal cancer, often related to Barrett's esophagus and obesity.

    Risk Factors for SCC

    Includes alcohol, smoking, low socioeconomic status, and certain dietary habits.

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    Diagnosis Methods

    Common methods include gastroscopy with biopsy, endoscopic ultrasound, and CT scans.

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    Treatment Options

    Surgery is usually preferred; options may include chemoradiotherapy and brachytherapy.

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    Poor Prognostic Factors

    Tumors larger than 5cm, significant weight loss, and esophageal obstruction signal a worse outcome.

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    Common Symptoms

    Include dysphagia, odynophagia, weight loss, vomiting, cough, and hoarseness.

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    HNPCC/Lynch syndrome

    A hereditary condition increasing risk for colon and other cancers due to MSI.

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    CEA

    Carcinoembryonic antigen, a tumor marker for colon cancer; used to monitor treatment.

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    Right-sided vs Left-sided cancer

    Right-sided cancer often presents with anemia; left-sided may cause obstruction and pencil-shaped stools.

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    Rectal cancer prevalence

    Less common than colon cancer, accounting for 16% of colorectal cancers.

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    Stage I & II rectal cancer treatment

    Managed by surgery through total mesorectal excision (TME).

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    Stage III rectal cancer treatment

    Requires pre-operative radiotherapy followed by surgery, possibly post-operative chemotherapy.

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    Anal cancer risk factors

    Increased risk due to HPV, immunodeficiency, and anal intercourse.

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    Anal cancer peak incidence

    Most common in individuals in their 50s; more frequent in males (4x greater than females).

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    Adenocarcinoma

    The most common subtype of colorectal cancers, especially prevalent in rectal cancer.

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    5YS Dukes prognosis

    Five-year survival rates: Dukes A=80-90%, B=70-80%, C=30-50%; indicates cancer progression.

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    Sarcomas

    A type of cancer that arises from mesenchymal tissues like bone, fat, and muscle.

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    MRI for STS

    Magnetic Resonance Imaging is the preferred method to diagnose soft tissue sarcomas.

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    Risk factors for sarcomas

    95% of sarcoma cases have unknown causes, with some hereditary syndromes and environmental factors like radiation.

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    Soft tissue sarcoma types

    Includes liposarcoma, leiomyosarcoma, rhabdomyosarcoma, and more.

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    Prognosis of sarcomas

    Low grade sarcomas have a 15% metastasis risk; high grade increases to 50%.

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    Intestinal Adenocarcinoma (AC)

    A type of cancer with a high rate in Japan, poor prognosis (50% 5YS for T1; 3% for stage IV), related to chronic gastritis and H.Pylori.

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    Diffuse Adenocarcinoma

    A stable-incidence cancer that affects both genders equally, associated with EBV and CDH1 mutation, generally has a better prognosis.

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    Virchow's Node

    A left supraclavicular lymph node that indicates metastasis from abdominal cancers, noted in Troisier's sign.

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    Epigastric Pain

    Pain in the upper central region of the abdomen, often presenting in various gastrointestinal disorders.

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    Hepatocellular Carcinoma

    The most common subtype of liver cancer, often arising from chronic hepatitis or cirrhosis, with a generally poor prognosis.

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    Fibrolamellar Carcinoma

    A rare subtype of hepatocellular carcinoma that typically has better prognosis and commonly appears in younger individuals.

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    Triple Negative Breast Cancer

    Breast cancer subtype lacking ER, PR, and HER2 expression, associated with the worst prognosis.

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    Luminal A Breast Cancer

    The most common breast cancer subtype, hormone receptor-positive with the best prognosis and responsiveness to hormonal therapy.

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    Paraneoplastic Syndromes

    Symptoms that occur due to cancer, not directly from tumor invasion, including Acanthosis Nigricans and Leser-Trélat syndrome.

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    AFP Level in HCC

    Alpha-fetoprotein level often increased in hepatocellular carcinoma but not used for screening or diagnosis.

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    Colon Cancer

    The 3rd most common cancer and a leading cause of cancer deaths.

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    Colonoscopy

    A diagnostic procedure used to examine the colon and rectum.

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    Biopsy

    A tissue sample taken to diagnose cancer.

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    Staging Systems

    Dukes, Astler-Coller, and AJCC/TNM are methods to classify cancer's extent.

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    Risk Factors

    Conditions increasing likelihood of developing colon cancer.

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    Familial Adenomatous Polyposis (FAP)

    An inherited condition leading to numerous polyps and high cancer risk.

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    Surgery Options

    Resection is the best option for early-stage colon cancer.

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    Chemo Treatment

    FOLFOX is a chemotherapy regimen for advanced colon cancer.

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    Metastatic Stage

    20-25% of colon cancer diagnoses occur when the cancer has spread.

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    Molecular Testing

    Tests for mutations like KRAS, NRAS, and BRAF to guide treatment.

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    Study Notes

    Esophageal Cancer

    • Epidemiology: Rare cancer (1% of all cancers in Western world; Squamous Cell Carcinoma (SCC) more common globally)
    • Malignancy prevalence: More common in men, typically diagnosed after age 45 (SCC), or 70 (Adenocarcinoma)
    • Distinguishing Subtypes:
      • Squamous Cell Carcinoma (SCC): Associated with alcohol, tobacco use, low socioeconomic status, poor diet, and certain chemicals. Predominantly affects the middle third of the esophagus.
      • Adenocarcinoma: Linked to Barrett's esophagus (a complication of GERD), obesity, tobacco, and possibly radiation exposure. Generally found in the distal third of the esophagus.

    Esophageal Cancer - Diagnosis

    • Gastroscopy with Biopsy: Essential diagnostic procedure.
    • Endoscopic Ultrasound (EUS): Further evaluation for tumor size and location.
    • Computed Tomography (CT): Used to detect distant metastasis.
    • Blood Tests: Measuring liver enzymes to assess potential spread of the disease.

    Esophageal Cancer - Treatment

    • Surgery: Primarily used, often with pre-operative radiotherapy (RT) or chemotherapy (chemo) if possible.
    • Chemoradiotherapy: An alternative to surgery for inoperable cases.
    • Intracavital Brachytherapy: A cancer treatment that involves using radiation delivered directly to the tumor. Used if other options not suitable.

    Esophageal Cancer - Progression & Prognosis

    • Poor Prognosis Factors: Tumor size exceeding 5cm, significant weight loss, obstructed esophagus, and a high-grade tumor.
    • Metastasis: Can spread to lymph nodes in the lungs, liver, and other organs.
    • Overall Prognosis: Typically not a favorable prognosis.

    Colon Cancer

    • Epidemiology: Third most common gastrointestinal (GI) cancer, responsible for 10% of cancer deaths; highest incidence in age group 60-70. Equal prevalence between men and women.
    • Risk Factors/Etiology: Genetic predisposition (e.g., familial adenomatous polyposis (FAP), Lynch syndrome), poor diet (refined carbs, low fiber), high fat intake, IBD, and blood type O are some risk factors are prevalent.
    • Subtypes: Predominantly adenocarcinomas, but can arise from other sources; with a high risk of additional cancers in patients with familial adenomatous polyposis (FAP) and Lynch syndrome.

    Colon Cancer - Diagnosis

    • Colonoscopy with Biopsy: The primary diagnostic method.
    • Imaging: Computed Tomography (CT) scans of the abdomen and chest to look for distant metastasis.
    • Molecular Testing: Testing for genetic mutations (KRAS, NRAS, BRAF, MSI) to guide treatment decisions, focusing on family history for Lynch or FAP.

    Colon Cancer - Treatment

    • Surgical resection is the frontline treatment in Stages I and II (remove tumor and affected section).
    • Chemotherapy: Used in Stages III and IV (after or in conjunction with surgery, to fight metastasis), with often targeted therapy (e.g., anti-EGFR) if specific mutations are present.

    Colon Cancer - Progression & Prognosis

    • Metastatic Stage: 20-25% of patients are diagnosed at metastatic stage initially.
    • Prognostic factors include tumor size, lymphatic involvement, and the number of involved lymph nodes.

    Rectal Cancer

    • Epidemiology: Less prevalent than colon cancer, accounting for 16% of colorectal cancers.
    • Risk Factors/Etiology: Similar risk factors to colon cancer (e.g., genetics, diet, inflammatory bowel disease (IBD)).
    • Subtypes: Primarily adenocarcinoma, but also squamous cell carcinoma (SCC), and neuroendocrine tumors.
    • Presentation: Typically presented with bleeding from the anus, constipation, and/or diarrhea, and abdominal pain.
    • Diagnosis: Colonoscopy with biopsy, CT/MRI to assess for metastasis.
    • Treatment: Stage I and II often treated with surgery (total mesorectal excision [TME]); Stage III may involve pre-operative radiation therapy (RT), while Stage IV usually involves chemotherapy (chemo).
    • Progression & Prognosis: 5-year survival rates vary depending on Duke's stage (A, B, C, or D).

    Anal Cancer

    • Epidemiology: Less prevalent than colon cancer, with a male to female ratio of ~4:1; common age range is 50s-70s.
    • Risk Factors/Etiology: Associated with human papillomavirus (HPV) infection including anal intercourse, immune deficiency (HIV), and smoking.
    • Subtypes: Predominantly squamous cell carcinoma; distal to the dentate line can be non or keratinizing. Anal margin tumors are skin cancers.
    • Diagnosis: Biopsy.
    • Treatment: Localized tumors often treated with radiation therapy (RT) or combined chemo/RT, surgical intervention reserved for advanced cases.

    Pancreatic Cancer

    • Epidemiology: 5th most common cancer; usually diagnosed at an advanced age (60-80). More prevalent in men.
    • Risk Factors/Etiology: Smoking, fatty/meat-heavy diet, chronic pancreatitis, diabetes, and genetic predisposition (e.g., Peutz-Jeghers syndrome).
    • Subtypes: 90% are ductal adenocarcinomas, mostly affecting the head of the pancreas.
    • Presentation: Symptoms such as fever, weight loss, back pain, impaired digestion, jaundice (obstruction of bile ducts), Courvoisier sign (palpable gallbladder), and Trousseau sign (migratory thrombophlebitis), are frequently reported.
    • Diagnosis: Imaging (CT, MRI), biopsy, marker testing (Ca19-9), alongside genetic screening in cases with elevated risk.
    • Treatment: Typically involves surgery (Whipple procedure or pancreatectomy); chemotherapy (combination regimens) is frequently utilized, particularly post-surgery.
    • Progression & Prognosis: Very poor prognosis, often with early metastasis to regional nodes (liver, lungs), and a high tendency to invade adjacent structures; more favorable outcomes associated with earlier diagnosis.
    • Other Considerations: Markers of possible secondary cancers (i.e., distant spread) can also be determined from tests/imaging.

    Gastric Cancer

    • Epidemiology: Common in Japan and China; declining incidence elsewhere, but remains a major cause of cancer death in certain regions. Primarily adults > 50 years of age.
    • Risk Factors/Etiology: Chronic gastritis (H. Pylori), poor diet, genetics (e.g., hereditary diffuse gastric cancer syndrome), and a history of partial gastrectomy.
    • Subtypes: Predominantly adenocarcinoma; two main types: intestinal-type and diffuse-type.
    • Diagnosis: Gastroscopy with biopsy, CT scan to assess metastasis.
    • Treatment: Surgery (total or partial gastrectomy and lymphadenectomy), combined with chemotherapy (chemo when needed) or radiotherapy (RT) depending on the stage of cancer spread.
    • Progression & Prognosis: Poor overall survival rates, with factors including tumor stage influencing survival and treatment plan.
    • Presentation: Epigastric pain, weight loss, vomiting, potentially hematemesis, dysphagia.

    Liver Cancer

    • Epidemiology: 5th most common cancer globally; significantly prevalent in parts of Asia and Africa.
    • Risk Factors/Etiology: Viral hepatitis (HCV > HBV), alcohol abuse, cirrhosis, aflatoxins (a toxin in certain foods), and non-alcoholic fatty liver disease.
    • Subtypes: Predominantly hepatocellular carcinoma (HCC); other less common types exist.
    • Diagnosis: Imaging (CT, MRI, ultrasound); tumor markers (e.g., alpha-fetoprotein); liver biopsy.
    • Treatment: Surgery (if possible); some cases are not operable or have spread, thus treatment involves chemo and/or targeted therapy.
    • Prognosis: Generally poor, highly dependent on the stage of cancer spread.

    Breast Cancer

    • Epidemiology: MC non-skin cancer in women, 2nd most common cause of death after lung cancer. High incidence for women over 50.
    • Risk Factors/Etiology: Genetic mutations (BRCA1/2), age, family history of breast/ovarian cancer, early menarche, late menopause, high alcohol consumption, obesity, hormonal factors, or racial factors.
    • Subtypes: Various subtypes (e.g., luminal A, B, HER2-positive, triple-negative) based on receptor expression profile on the tumor’s cells.
    • Presentation: Painless lump, skin changes, nipple discharge or retraction, nipple inversion, or inflammation; sometimes accompanied by axillary lymph node swelling.
    • Diagnosis: Mammogram, ultrasound, biopsies, and genetic testing.
    • Treatment: Varies depending on the subtype and stage of cancer, often involving surgical interventions (lumpectomy or mastectomy), radiation therapy (RT), hormonal therapy, targeted therapy, and chemotherapy (chemo).

    Mesenchymal Cancer (Sarcomas)

    • Epidemiology: Rare tumors, arising from mesenchyme; the occurrence and risk factors differ based on the specific sarcoma type.
    • Risk Factors/Etiology: Usually unknown, but some rare genetic syndromes/inherited predisposition and environmental/acquired factors may increase risk.
    • Subtypes: Diverse types exist (e.g., liposarcoma, leiomyosarcoma, rhabdomyosarcoma, osteosarcoma, chondrosarcoma, and gastrointestinal stromal tumors (GISTs)).
    • Diagnosis: Imaging (MRI, CT), biopsy, tissue analysis.
    • Treatment: Often involves a combination of surgery, radiation therapy, and chemotherapy. The treatment approach is tailored based on the tumor type, grade, and patient's overall health.

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    Description

    Dive into the crucial aspects of esophageal cancer, including its epidemiology, malignancy prevalence, and distinguishing subtypes like Squamous Cell Carcinoma and Adenocarcinoma. Learn about essential diagnostic procedures such as gastroscopy, endoscopic ultrasound, and the role of blood tests in evaluating the disease.

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