Which of the following represents a well-known risk of adenocarcinoma of the esophagus? Helicobacter pylori infection; cigarette smoking; long-standing gastroesophageal reflux disease (GERD); achalasia; alcohol use

Long-standing gastroesophageal reflux disease (GERD). The article explains that GERD increases the risk of esophageal adenocarcinoma, which tends to occur in the distal esophagus and gastroesophageal junction and is associated with obesity and Barrett's esophagus.

Which histologic subtype of esophageal cancer is more frequently associated with smoking, achalasia, and alcohol use?

Squamous cell carcinoma. The article states SCC is associated with smoking, achalasia, and alcohol abuse.

Does Helicobacter pylori infection increase the risk of esophageal cancer?

No — H. pylori infection may be protective against esophageal cancer according to the article.

In a patient with progressive dysphagia, weight loss, and an ulcerating lesion at the gastroesophageal junction, which diagnosis was confirmed by endoscopy and biopsy in this case?

Adenocarcinoma at the gastroesophageal junction. The article's vignette reports biopsy-proven adenocarcinoma in that location.

internal medicine

Internal Medicine Board-style Case: Dysphagia and Weight Loss

Internal Medicine board-style dysphagia case: approach, key clues, and exam-style rationale for progressive dysphagia with weight loss.

Med-Challenger

Feb 17, 2025

internal medicine Personal Education Question of the Week quick quiz

Board-style vignette to practice recognition and initial diagnostic approach to progressive dysphagia with weight loss; focus on high-yield clues, differential prioritization, and exam answer strategy for Internal Medicine boards.

A 61-year-old man presents with dysphagia and weight loss. On esophagogram, he is found to have a suspicious ulceration (see Figure). Subsequent endoscopy and biopsy reveal adenocarcinoma at the gastroesophageal junction (see Figure).

Most Missed: esophageal cancer

Figure.

Which of the following represents a well-known risk of adenocarcinoma of the esophagus?

Helicobacter pylori infection
cigarette smoking
long-standing gastroesophageal reflux disease (GERD)
achalasia
alcohol use

The correct answer is:

long-standing gastroesophageal reflux disease (GERD)

Educational Objective:

Discuss GERD and esophageal cancer.

Key Point:

GERD increases the risk of adenocarcinoma of the esophagus. Alcohol and tobacco abuse are more frequently associated with squamous cell cancer of the esophagus.

Explanation:

The two major histologic subtypes of esophageal cancer are squamous cell carcinoma (SCC) and adenocarcinoma (AC). H pylori infection may be protective against esophageal cancer. SCC is associated with smoking, achalasia, and alcohol abuse. AC tends to occur in the distal esophagus and gastroesophageal junction, particularly in the setting of GERD, obesity, or Barrett’s esophagus, which is thought to be a complication of GERD.

References:

Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349(23):2241-2252.

Rustgi AK. Neoplasms of the esophagus and stomach. In: Goldman-Cecil Medicine, 2016; 192: 1313-1320

This question appears in Med-Challenger Internal Medicine Exam Review with CME

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