A 59-year-old man with esophageal cancer is presented with wheezing and weight loss. What is the likely cause of his symptoms?

The symptoms presented in the case, particularly the wheezing and weight loss in a patient with esophageal cancer, suggest that the malignancy may be impacting surrounding structures. The most likely cause of these symptoms is the direct extension of the cancer into adjacent organs or tissues, which can lead to airway compromise and resultant wheezing.

As esophageal cancer progresses, it can invade nearby structures such as the trachea or bronchi. This invasion can cause obstruction or irritation of the airways, leading to wheezing and difficulty with airflow. The weight loss is also consistent with malignancies, which often cause systemic effects, including decreased appetite and increased metabolic demands.

While acid reflux irritation could potentially lead to respiratory symptoms, it is less likely to cause wheezing in such an acute manner compared to the direct mechanical effects of the tumor itself. Similarly, bronchial obstruction and lung metastases could also lead to wheezing, but in the context of this specific case where there is esophageal cancer, the more direct cause related to the primary malignancy's growth and local invasion is the most plausible explanation for the symptoms described.