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January 14, 1974

Surgical Principles of Resection and Reconstruction

JAMA. 1974;227(2):176-178. doi:10.1001/jama.1974.03230150028007

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Cancer of the esophagus usually has a bad prognosis, primarily because the diagnosis is made late, and localized disease is not seen frequently. The esophagus is a muscular tube that dilates in the presence of gradual, partial obstruction, which does not produce symptoms until some time has elapsed. The patient frequently does not see his physician until he has had dysphagia for a long period of time, or until complete obstruction has occurred. It is surprising how long patients will tolerate dysphagia of a mild-to-moderate degree, limiting themselves to a soft or semiliquid diet before they seek help. The actual occurrence of dysphagia is a late symptom in cancer of the esophagus. Pain in the retrosternal region usually results from the attempt to swallow food past a partial or almost complete obstruction. Radiating pain, or pain in the back usually indicates extension of disease outside the limits of the esophagus,