The cause of esophageal cancer is unknown, but predisposing factors include chronic irritation caused by heavy smoking and excessive use of alcohol, stasis-induced inflammation, and nutritional deficiency. Esophageal tumors are usually fungating and infiltrating. Most arise in squamous cell epithelium, a few are adenocarcinomas, and fewer still are melanomas and sarcomas.

Esophageal cancer has a 5-year survival rate below 10%, and regional metastasis occurs early by way of submucosal lymphatics. Metastasis produces such serious complications as tracheoesophageal fistulas, mediastinitis, and aortic perforation. Common sites of distant metastasis include the liver and lungs.

Patients are usually asymptomatic until they’re far advanced in the disease. Dysphagia and weight loss are the most common presenting symptoms. Dysphagia is mild and intermittent at first, but it soon becomes constant. Pain, hoarseness, coughing, and esophageal obstruction follow. Cachexia usually develops.