The patient had increased difficulty swallowing and as a result had lost 5 pounds in 6 weeks. He had no airway problems and neck examination was negative for any masses. He has a 30-pack per year history of smoking cigarettes and currently smokes 10 cigarettes per day. He drank 1 quart of alcohol per week in his 30's, but now only has 1-2 alcoholic drinks per week. He has no history of alcohol withdrawal and he has no chemical exposure. His past medical history and past surgical history are otherwise unremarkable.