Esophageal cancer

1. • Data collected by : Ahmad shurbaji

2.  Esophageal cancer is the 7th
leading cause of cancer
deaths.
 In some regions, such as
areas of northern Iran,
southern Russia, and
northern China, the
incidence reaches 800 per
100,000 population.
 The incidence rises steadily
with age, reaching a peak in
the 6th to 7th decade of life.
 Male : Female = 3.5 : 1

3.  Benign: are rare leiomyoma is the most common, and is
usually small, asymptomatic and discovered incidentally
 Malignant : Esophageal cancer is the 7th most common
tumor in humans
 Commonest types:
› Squamous cell carcinoma 90%
› adenocarcinoma

4. Predisposing factors
› 1) Dietary:
 Fungal contamination of food (Aspergillus)
 High content of nitrites/nitrosamines
 Deficiency of vitamins (A, C, riboflavin, thiamin)
 Deficiency of trace metals (zinc)
› 2) Esophageal disease: achalasia, reflux esophagitis
strictures,
› 3) Lifestyle: Alcohol , tobacco abuse & burning-hot food
› 4) Racial or genetic : blacks; celiac disease,
Tylosis( hyperkeratosis of palms & soles).
5) HPV human papilloma virus

5.  Pathology:
› 50% in mid third; 30% in lower third; 20% in upper
third of esophagus
› Starts as cancer in situ with mucosal thickening
› Gross: Polypoid fungating (60%); ulcer (25%); diffuse
(15%)
› Stages: I (<5 cm), II (>5 cm; resectable ), III (>10 cm;
extension to adjacent tissue; inoperable);
IV (perforation; metastasis)
 Clinical feature: symptoms are gradual & late; include
dysphagia, extreme weight loss, aspiration pneumonia,
hemorrhage & sepsis
 Prognosis : Poor 70% die within 1 yr; 5 yrs survival 5-10%
 Rx: surgery & radiotherapy
Squamous cell carcinoma

12.  5-10% of esophageal cancers
 lower third mainly; may extend to stomach
 Vast majority arise from Barrett’s esophagus
 Most are adults >40 yrs; M:F=5:1; v. rare in blacks
 Gross : Mass or nodular elevation of mucosa; frequently
multicentri
 Clinically: progressive painful dysphagia, Regurgitation and
sialorrhea, hematemesis, weight loss.
supraclavicular or cervical adenopathy can be discovered
by palpation.
 Prognosis : Poor.
 Rx: surgery , radiotherapy & Chemotherapy

13. Pathology
Adenocarcinomas arise from glandular epithelioma
with a papillar or tubular structure.
Most adenocarcinomas arise from Barrett
metaplasia or from glandular metaplasia in the
esophageal mucosa.
Adenocarcinomas mainly arise in the distal third
and gastroesophageal junction

14. Adenocarcinoma of the esophagus showing
Irregular neoplastic glands infiltrating the esophageal
mucosa

16. 1-) A metaplastic alteration of the normal
esophageal epithelium above GEJ that is
detected on endoscopic examination and
pathologically confirmed by the
presence of intestinal metaplasia (goblet cells)
on biopsy.
2-) Due to chronic GERD (gastro-esophageal reflux
disease)
3-) About 10% of people with chronic symptoms
of GERD develop Barrett's esophagus.

17.  Acid-induced injury to the native squamous cell
epithelium of the esophagus leads to epithelial
repair; eventually, but only in some cases, columnar
epithelium can replace offering greater tolerance to
low pH, but also a tendency towards dysplastic
change predisposing to esophageal
adenocarcinoma.
:
The cells of Barrett's esophagus, after biopsy, are
classified into four general categories: non-
dysplastic, low-grade dysplasia, high-grade
dysplasia, and frank carcinoma.

18. Barrett’s Esophagus – Columnar Cells Extend Above the GE Junction

19. Progression of disease, demonstrating changes observed
as esophagitis (A) undergoes metaplasia, leading to
salmon-colored mucosal changes in the distal esophagus
characteristic of Barrett’s esophagus (B) Dysplasia
develops (C).

20. clinical presentation
 frequent and longstanding heartburn
vomiting blood (hematemesis)
diagnosis
Both macroscopic (from endoscopy) and
microscopic

21. Treatment
One of the primary goals of treatment is to prevent or slow the
development of Barrett's esophagus by treating and controlling
acid reflux
This is done with lifestyle changes, medication, & surgery
Lifestyle changes
Minimize Fatty foods, chocolate, caffeine
Avoid alcohol
Medications
.
Antacids
Proton pump inhibitors that reduce the production of stomach
acid.
Surgery:
Endoscopic mucosal resection (EMR)