Carcinoma (from the Greek karkinos, or
"crab", and -oma, "growth")
Carcinoma of Esophagus
Carcinoma is a malignant neoplasm of epithelial cell origin.
Carcinoma- Malignant epithelial
• Most (> 99%)esophageal tumors are MALIGNANT,
fewer than 1% are benign.
• Benign tumors: Squamous cell papilloma,
Adenoma, leiomyoma, lipoma, fibroma,
neurofibroma, rhabdomyoma, lymphangioma &
• Malignant tumors: are carcinomas because
sarcomas are extremely rare.
Carcinoma of esophagus
Two morphologic variants :
I . Adenocarcinoma
II. Squamous cell
• Worldwide, squamous cell
carcinoma is more common, but in
the United States and other Western
countries adenocarcinoma is on the
• A general rule of thumb
is that a cancer in the upper twothirds is a squamous cell carcinoma
and one in the lower one-third is an
Adenocarcinoma denotes a lesion in which the
neoplastic epithelial cells grow in glandular
Adenocarcinoma of the esophagus typically arises in
a background of Barrett esophagus and
Strong association with Barrett Esophagus
Risk of adenocarcinoma
Age- over 60 (6th -7th decades)
Sex- more common in MEN (7times)
prior radiation therapy.
Risk is reduced
Barrett esophagus is the only recognized precursor of esophageal adenocarcinoma.
The degree of DYSPLASIA is the strongest predictor of the progression to cancer.
Dysplasia---Carcinoma in situ--Invasive Carcinoma
Esophageal adenocarcinoma usually occurs in the
distal third of the esophagus and may invade
the adjacent gastric cardia. Initially appearing as
flat or raised patches in otherwise intact
mucosa, large nodular masses of 5 cm or more
in diameter may develop. Alternatively, tumors
may infiltrate diffusely or ulcerate and invade
elevated mass in the lower esophagus
of Esophageal Adenocarcinoma
• Barrett esophagus is
frequently present adjacent
to the tumor.
• Tumors most commonly produce
mucin and form glands, often with
• less frequently tumors are
composed of diffusely
infiltrative signetring cells or,
• in rare cases, small
• By the time symptoms appear, the tumor has
usually spread to submucosal lymphatic vessels.
As a result of the advanced stage at diagnosis,
overall 5-year survival is less than 25%(15%) with
most patients dying within the first year of
• In contrast, 5-year survival approximates 80% in
the few patients with adenocarcinoma limited to
the mucosa or submucosa.
Squamous (Epidermoid) cell
a cancer in which the tumor cells
resemble stratified squamous
of esophageal cancer.
Risk factors of SCC of Esophagus
•Life style or Bad habits
Age, Sex, Poverty, Radiation, Race, HPV, Celiac disease.
I. Esophageal disorders:
• Long standing esophagitis
• Plummer-Vinson Syndrome
II. Life style:
• An important contributing variable is retarded
passage of food through the esophagus,
prolonging mucosal exposure to potential carcinogens such
as those contained in tobacco and alcohol beverages.
• There is a well-defined predisposing role for chronic
esophagitis, which is often the consequences of
alcohol and tobacco use.
III. Dietary Factors
• Def. of vit.
• Def. of trace metals
• Fungal contamination of food stuffs
• High content of nitrites/nitrosamines
• Frequent consumption of very hot beverages.
IV. Genetic predisposition:
Nonepidermolytic palmoplantar keratoderma.
A genetic disorder characterized by
thickening (hyperkeratosis) of the palms
and soles, white patches in the mouth
(oral leukoplakia), and a very high risk
of esophageal cancer.
• Abnormalities affecting the p16/INK4
tumor suppressor gene and the
epidermal growth factor receptors are
frequently present in SCC of the
esophagus. Mutation in
of these tumors.
V. Age. Over 45
VI. Sex. Males
times more frequently than
VII. Race- more common in BLACKS (6 times)
IX. Previous radiation therapy to the
XI. Coeliac disease
• Esophageal squamous cell carcinoma incidence
varies up to 180-fold between and within
countries, being more common in
• The regions with highest incidences are
China, Hong Kong,
Brazil, and South Africa.
The majority of esophageal squamous cell
carcinomas in Europe and the United States
are at least partially attributable to the use of
ALCOHOL AND TOBACCO ,
which synergize to increase risk.
Pathogenesis of sCC
• However, esophageal squamous cell carcinoma is
also common in some regions where alcohol and
tobacco use is uncommon. Thus,
• nutritional deficiencies, as well as
• polycyclic hydrocarbons, nitrosamines, and
• other mutagenic compounds, such as those found
in fungus-contaminated foods, must be
Pathogenesis of sCC
• Human papillomavirus (HPV)
infection has also been implicated in
esophageal squamous cell carcinoma
in high-risk areas but not in lowrisk regions.
Pathogenesis of sCC
• The molecular pathogenesis of esophageal
squamous cell carcinoma remains
several tumor suppressor
genes, including p53 and
p16/INK4a, is involved.
incompletely defined, but
• Weight loss
• Squamous cell carcinoma begins as an in situ lesion termed
• Epithelial dysplasia
• Carcinoma in situ
• Invasive cancer
• Early overt lesions appears as:
plaquelike thickenings or
elevation of the mucosa..
In months to years these lesions become
tumorous, taking one of three forms:
1. Polypoid fungating type (60%): The most common
type. Cauliflower-like friable mass protruding into the
• 2. Ulcerating type (25%): A necrotic ulcer with
everted edges that extend deeply and sometimes
erode into the respiratory tree (Pneumonia), aorta
• 3. Diffuse infiltrative type (15%): appears as
annular, stenosing narrowing of the lumen due to
infiltration into the wall of esophagus.
• SCC arise about (locations):
• 20% in the cervical& upper thoracic esophagus
50% in the middle third
• 30% in the lower third
• Most squamous cell carcinomas are moderately to
Keratinization &Epithelial pearls
are commonly seen.
Karatin pearl l
Regardless of histology,
symptomatic tumors are generally
at diagnosis and have already invaded the
• Less common histologic variants include
• verrucous squamous cell carcinoma,
• spindle cell carcinoma, and
• basaloid squamous cell carcinoma
• 5-year survival rates are 75% in individuals with
superficial esophageal carcinoma but much lower
in patients with more advanced tumors.
• Lymph node metastases, which are common, are
associated with poor prognosis.
• The overall 5-year survival
remains a dismal 9%.
Esophageal cancer. A, Adenocarcinoma usually occurs distally and, as in this
case, often involves the gastric cardia. B, Squamous cell carcinoma is most
frequently found in the mid-esophagus, where it commonly causes strictures.