esoph ca.pptx

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WinstonM3

review of causes, clinical assessment, investigation of esophageal cancer

Health & Medicine

ESOPHAGEAL CANCER
Dr Winston Makanga, M.B.Ch.B., M.Med. (Surg)
Consultant General and Laparoscopic Surgeon

Outline
• Pathology
• Etiology
• Presentation
• Investigation
• Management

Kenya
• Central rift
• Western
• Central
• M:F = 3:1
• Age 50-80

Anatomy
• Tubular organ
• 3 layers, No serosa
• 3 divisions
• Lymphatics in the submucosa

Pathology
• Primary
• Sq. cell carcinoma
• Adenocarcinoma
• Leiyomyosarcoma
• Secondary
• Broncogenic ca
• Lung cancer
• Spread
• Local
• Nodal
• Distant
• Starts as epithelial disease
• In a closely packed space with major surrounding organs
• Lack of serosal covering means no barrier
• Dysphagia affects nutrition early
• Metastasis are not main cause of death

• Ulcerative
• Exophytic/polypoid
• Infiltrative
• 20% upper
• 50% middle
• 30% lower

Etiology/risk factors
• Diet
• High fibre
• Smoked fish
• Hot fluids/feeds
• Phytates
• Alcohol
• Smoking
• Viral esophagitis
• Plummer-Vinson
• GERD/Barrets

Presentation
• Assymptomatic
• Progressive Dysphagia
• Cachexia (wasting, weakness, anemia)
• If metastasis present
• Nodes
• Jaundice
• Hepatomegaly and ascites

Investigation
• Hemogram, UEC, LFT
• Contrast radiography
• Endoscopy with biopsy
• CT scan
• Endoscopic ultrasound
• Others
• PET scan
• Bronchoscopy
• Diagnostic laparoscopy

Staging
1. Small local disease
2. Large local disease
3. Local infiltration
or Nodal disease
4. Distant spread

Differentials
• All other causes of dysphagia
• Benign strictures
• Webs
• Achalasia
• Motility disorders

Management
• Local excisions
• Endoscopic mucosal resection
• Endoscopic submucosal dissection
• Curative resection (+NACT)
• Trans-thoracic
• Trans-hiatal
• Palliation
• Endoluminal stenting
• Laser recanalizaton
• Chemotherapy
• Radiotherapy
Must assess fitness for surgery
Tumor should be local

Review
• Pathology
• Etiology
• Presentation
• Investigation
• Management

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