Although the overall number of cases of EC in the United States continues to rise—estimated at 13,900 cases in 2003—the change in epidemiology is more striking. Squamous cell cancer (SCC) used to be the most common histology; however, due to a steady increase in adenocar-cinoma (AC) over the past several decades, this histology currently makes up the majority of new diagnoses. Most of these cases are thought to arise from Barrett's esophagus (BE), a premalignant condition that results from chronic gastroesophageal reflux that is likely exacerbated by obesity and hiatal hernia.

Concurrent with the emergence of two distinct histo-logic types is the necessity of considering the differences between these two entities when initially assessing a patient.

Although the treatment approach typically does not vary greatly by histologic type of EC, differences in epidemiology, pathophysiology, and tumor behavior may impact management. SCC is more common in patients with a history of alcohol and tobacco use, is stable in incidence in the united states, tends to be located in the upper and middle esophagus, and has a greater tendency to recur locally. Locoregional nodes occur in the upper mediastinum, and mestastatic disease is more commonly found in the supra-clavicular nodes and lung parenchyma. AC is related to gas-troesophageal reflux and BE, is increasing in incidence, occurs usually in the distal esophagus and gastroesophageal junction, and is more likely to recur in abdominal nodes and distant organ sites. Locoregional nodal spread is via the retroperitoneum to include the celiac and gastrohep-atic regions, whereas metastases typically are found in the liver and occasionally on the peritoneum. Finally, differentiating distal esophageal AC from primary gastric cancer is also critical, as treatment of these two cancers differs.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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