Which of the following statement(s) is/are true concerning the pathology of squamous cell carcinoma of the esophagus?

e. Lymph node metastases are present in at least 75% of patients at the time of initial diagnosis

Pathologically, esophageal carcinoma occurs over a spectrum that ranges from the early lesion (carcinoma in situ), which is limited to the mucosa, to the more advanced form, in which the tumor penetrates the muscle layers of the esophagus and beyond. Carcinoma in situ typically is found in patients between 40 and 50 years of age and gradually progresses to invasive squamous cell carcinoma over two to four years. Using the arbitrary division of the esophagus, 8% of squamous cell carcinomas occur in the cervical esophagus, 55% in the upper and mid-thoracic segments, and 37% in the lower thoracic segment which extends to the GE junction. Macroscopically, 60% of squamous cell carcinomas of the esophagus are fungating intraluminal growths, 25% of ulcerative lesions are associated with extensive infiltration of the adjacent esophageal wall, and 15% are infiltrating. Esophageal carcinoma tends to be multi-focal, and a patient who survives treatment of one carcinoma has at least twice the risk of developing a second primary esophageal neoplasm than the normal population.

Esophageal carcinoma is notorious for its aggressive biologic behavior. Mediastinal, supraclavicular, or celiac lymph node metastases are present in at least 75% of patients with esophageal cancer at the time of initial diagnosis. Unfortunately, when lymph node metastases are present, five-year survival is only 3%, compared with 42% when there is no lymph node spread.