Progressive dysphagia is seen in-

Carcinoma of the oesophagus Squamous oesophageal cancer is relatively rare in Caucasians (4:100 000) but is more common in Iran, pas of Africa and China (200:100 000). Squamous cancer can occur in any pa of the oesophagus and almost all tumours in the upper oesophagus are squamous cancers. Adenocarcinomas typically arise in the lower third of the oesophagus from Barrett's oesophagus or from the cardia of the stomach. The incidence is increasing and is now approximately 5: 100 000 in the UK; this is possibly because of the high prevalence of gastro-oesophageal reflux and Barrett's oesophagus in Western populations. Despite modern treatment, the overall 5-year survival of patients presenting with oesophageal cancer is only 13%. Clinical features Most patients have a history of progressive, painless dysphagia for solid foods. Others present acutely because of food bolus obstruction. In the late stages, weight loss is often extreme; chest pain or hoarseness suggests mediastinal invasion. Fistulation between the oesophagus and the trachea or bronchial tree leads to coughing after swallowing, pneumonia and pleural effusion. Physical signs may be absent but, even at initial presentation,cachexia, cervical lymphadenopathy or other evidence of metastatic spread is common. Ref Davidson edition23rd pg796