Malignant tumors of esophagus

1. MALIGNANT TUMORS OF ESOPHAGUS
DR. DEVKANT LAKHERA

2. MALIGNANT TUMOURS OF
OESOPHAGUS
 Intrinsic tumors - Carcinomas
 90% - Squamous cell origin.
 Lacks serosa
 Rest - adenocarcinomas -distal esophagus
 Mucosal lining upto GE junction – squamous lining

3. PRESENTATION
Elder male >60 (4:1)
C/F - Dysphagia.
Multifactorial causes
 Achlasia
 Lye strictures
 Celiac disease
 Plummer vinson
 Tylosis
 Radiation
Tobacco and alcohol consumption,
obesity, nutritional deficiencies,
hereditary exposure to various
environmental carcinogens

4. CHEST RADIOGRAPHS
 Mediastinal widening
 Soft tissue mass
 Esophageal gas-fluid level
Posteroanterior chest
radiograph shows
widening of the superior
mediastinum on the right

5. LATERAL
 Anterior tracheal bowing
 Thickening of posterior tracheal stripe
increased soft-tissue density in the retrotracheal space
with slight anterior bowing of the trachea, thickening of
the retrotracheal stripe inferiorly (curved arrow) caused by
direct invasion of this area by tumor.

6. BARIUM STUDIES.
 Initial investigating screening modality in patients with dysphagia
 Double-contrast barium study.
Early Advanced

7. EARLY CARCINOMA
Features on barium
 Patch of mucosal irregularity
 Sessile polyp
 Lobulated sessile lesion with or without
ulceration
There is focal nodularity in the midesophagus as a result of
poorly defined nodules and plaques, producing a confluent
area of disease.
B. In another patient with a more extensive lesion, there is
diffuse granularity of the mucosa.
Both cases there is focal irregularity and puckering of one
wall of the esophagus (arrows) without a discrete mass //
flattened zone of decreased compliance in the right wall of
mid esophagus – early malignancy

8. ADVANCED CARCINOMA – 4 DISTINCT PATTERNS
Infiltrating polypoidal
Ulcerative Varicoid

9. INFILTRATING
 irregular narrowing and constriction of the lumen
associated with a nodular or ulcerated mucosa and
abrupt, well-defined proximal and distal margins
 Shelflike, overhanging margins, producing true
annular lesions
Spread along submucosal layer - luminal narrowing and
obstruction // annular appearance, with shelf like proximal
and distal margins. B. In another patient, the cancer is
manifested by a relatively smooth, tapered area of
narrowing that could be mistaken for a benign stricture

10. POLYPOIDAL
 Polypoid carcinomas appear as lobulated or
fungating intraluminal masses, usually larger than
3.5 cm
 Area of ulceration caused by tumor necrosis.
 luminal encroachment and obstruction.

11.  A. Infiltrating lesion. B. Polypoid lesion

12. ULCERATIVE AND VARICOID
 Ulcerative- well-defined meniscoid ulcers
with a thick, irregular, radiolucent rim of
tumor surrounding the ulcer
 Varicoid carcinomas are those in which
submucosal spread of tumor results in
thickened, tortuous, or serpiginous
longitudinal folds, mimicking the appearance
of esophageal varices

13.  UGI swallow of the midesophagus in a 54-year-old man
with nodular distortion of the mucosal folds (arrow) due
to esophageal carcinoma.

14. MEDIASTINAL INVOLVEMENT
 Lymphatic spread of tumor to
paratracheal, subcarinal, or
paraesophageal lymph nodes
may lead to extrinsic
compression or displacement of
the esophagus, often at a
considerable distance from the
primary lesion
 smooth, extrinsic esophageal
impression with gently sloping,
obtuse borders.

15. LYMPHATIC METASTASES
 Lymphatic metastases from
esophageal cancer may be
manifested by discrete implants
adjacent to or remote from the
primary lesion.
 plaquelike, polypoid, submucosal, or
ulcerated lesions separated from the
main tumor by normal intervening
mucosa

16. COMPLICATION
 Tracheo-oesophageal
fistula
An ulcerative esophageal carcinoma (arrows) is present in
the midesophagus. B. A second esophagogram 4 months
after radiation therapy shows partial regression of the
tumor
with the development of a tracheoesophageal fistula

17.  Advanced esophageal carcinoma with
fistulas to the mediastinum and lung. In
both cases, there is direct communication
between the cancer and necrotic, tumor-
containing cavities (arrows)
 in the mediastinum (A) and right lung (B).