ROSH Gastrointestinal Practice Exam

A 72-year-old man with progressive dysphagia has a biopsy positive for squamous cell carcinoma. Which historical feature is most likely?

1. Exposure to industrial dyes

2. Gastroesophageal reflux disease

3. Lynch syndrome

4. Tobacco use

The correct answer is: Tobacco use

Tobacco use is strongly associated with squamous cell carcinoma of the esophagus. In particular, the risk is significantly elevated in individuals who smoke, as tobacco contains carcinogens that can lead to cellular changes and mutations in the esophageal lining. The malignant transformation is often a cumulative process over years of exposure. Additionally, this type of cancer is more common in men and tends to occur in older populations, aligning with the age of the patient in this scenario. The history of tobacco use would also correlate with a higher likelihood of developing dysphagia as the tumor progresses and obstructs the esophagus, contributing to the symptoms experienced by the patient. Other options, such as exposure to industrial dyes, gastroesophageal reflux disease (GERD), and Lynch syndrome, are generally not as prominently linked to squamous cell carcinoma in the esophagus compared to tobacco use. While GERD can be associated more with adenocarcinoma of the esophagus, it is less significant when considering squamous cell carcinoma's risk factors. Lynch syndrome is linked to certain gastrointestinal cancers, primarily colorectal, rather than esophageal cancers.