Initially, he noted difficulty with solid foods, but now has trouble swallowing even liquids. Over the last one month, he has noted increasing substernal pain. He admits to a 12 lb weight loss over the last two months. His past medical history is remarkable for a myocardial infarction two years ago. He has a long history of ethanol abuse and smokes one pack of cigarettes per day.
Physical exam is unremarkable.
The complete work-up points to a carcinoma in the middle third of the esophagus. Discuss the treatment options for this patient including the advantages and disadvantages and prognosis of each option. She complains of intermittent trouble eating solid foods. Recently liquids also give a sensation of discomfort and are occasionally regurgitated. A diagnosis of diffuse esophageal spasm is made.