1) The document discusses the histology, clinical presentation, diagnostic evaluation, and treatment modalities for esophageal cancer.
2) There are two main histological types - squamous cell carcinoma and adenocarcinoma, with the latter arising in the context of Barrett's esophagus.
3) Clinical presentations include dysphagia, weight loss, and odynophagia. Adenocarcinoma tends to metastasize to the liver and peritoneum while squamous cell carcinoma spreads intra-thoracically.
3. HISTOLOGY OF ESOPHAGEAL CANCER-
Squamous Cell Carcinoma- approx. one third of esophageal cancer
approx. 60% in middle third while 30% in distal third and 10% in proximal third
associated with widespread submucosal lymphatic dissemination
Adenocarcinoma- arise in context of Barrett esophagus, occurs in distal third
Rare Varieties- SCC with sarcomatous features, adenoid cystic ca, mucoepidermoid cancer, Adeno-squamous ca, small
cell carcinoma, leiomyosarcoma, lymphoma
No significant survival difference noted in patients with adenocarcinoma as compared with SCC.
4. CLINICAL PRESENTATION-
Cervical Esophageal Cancer- dysphagia and weight loss (Most common complaints)
hoarseness of voice (11-24%)
Thoracic Esophageal Cancer- Asymptomatic ( 6-10%)
progressive dysphagia a/w weight loss
odynophagia ( 20%)
other symptoms include hoarseness of voice, IDA, symptoms of distant metastasis
Adenocarcinoma – usually metastasize to intra-abdominal sites (liver and peritoneum)
SCC- usually intra-thoracic metastasis
5. DIAGNOSTIC EVALUATION-
• EUS is superior to CT scans in both T and N staging of esophageal cancer.
• The overall accuracy for T staging is approximately 85%, and for N staging, it is approximately
75%.
• EUS is highly operator dependent and is limited in its ability to accurately define relatively
superficial lesions as either T1 or T2
6. • CT scans are highly accurate
(approaching 100%) at detecting liver
or lung metastases and suggesting
peritoneal carcinomatosis (e.g.,
ascites, omental infiltration,
peritoneal tumor studding).
• Accuracy for detecting aortic
involvement or tracheobronchial
invasion exceeds 90%.
• A CT scan is inaccurate in
determining T stage and N stage.
In the detection of distant metastases, an
FDG-PET scan is superior to CT, with a
sensitivity, specificity, and accuracy all in
the range of 80% to 90%
7.
8. TREATMENT MODALITIES FOR ESOPHAGEAL CANCER -
A)Single Modality :
a) Endoscopic
b) Surgical Resection
c) Radiation Therapy
d) Chemotherapy
B) Combined Modality
