Carcinoma of the esophagus has geographical predilections and is common in areas like China, France, Southern Africa, and Central South America. It is more common in males over age 40 and risk factors include heavy alcohol and tobacco use, as well as deficiencies in certain vitamins and minerals. Symptoms include dysphagia, hoarseness, cough, and weight loss. Diagnosis involves procedures like barium swallow, endoscopy with biopsy, and CT or PET scans to determine staging. Treatment options include esophagectomy, radiation, chemotherapy, or palliative measures like dilation or stenting.

1. Ca Oesophagus
Dr. Bwanga A.Dr. Bwanga A.

2. Carcinoma of the Oesophagus
 Has a geographical predirectionHas a geographical predirection
 Common in China, France, Southern AfricaCommon in China, France, Southern Africa
& Central S. America.& Central S. America.

3. AETIOLOGY AND RISK
FACTORS
1.1. GENETIC AND FAMILIAL FACTORSGENETIC AND FAMILIAL FACTORS
a. Common in middle age & elderly-40a. Common in middle age & elderly-40
& above.& above.
b. Males>femalesb. Males>females
c. Race-Whites-adenocarcinomac. Race-Whites-adenocarcinoma
-Blacks-Sq. Cell carcinoma-Blacks-Sq. Cell carcinoma
d. Genetics-Tylosis tends to fever Sq. Celld. Genetics-Tylosis tends to fever Sq. Cell
Ca Development.Ca Development.

4. ENVIRONMENTAL FACTORS
 Heavy liquor consumption-Risk Sq. CellHeavy liquor consumption-Risk Sq. Cell
Ca.Ca.
 Smoking-More Sq. Cell Ca. thanSmoking-More Sq. Cell Ca. than
adenocarcinoma.adenocarcinoma.
 Combination of heavy alcohol consumptionCombination of heavy alcohol consumption
+ cigarette smoking deadly.+ cigarette smoking deadly.
 In India chewing betel nut & leaf.In India chewing betel nut & leaf.
 Swallowing pica (slica) Africa.Swallowing pica (slica) Africa.

5. ENVIRONMENT FACTORS
Cont.
 Chewing opium residuesChewing opium residues
 Ingestion of hot liquidsIngestion of hot liquids
 Deficiencies in protein, vitamin A&C,Deficiencies in protein, vitamin A&C,
riboflavin, Zinc, Molybdenumriboflavin, Zinc, Molybdenum
 Diets rich in nitrites, nitrates &Diets rich in nitrites, nitrates &
nitrosamines.nitrosamines.

6. Pre-existing esophageal diseases
 Plummer-vision syndromePlummer-vision syndrome
 Lye strictureLye stricture
 Achalasia cardia- Prolonged exposure toAchalasia cardia- Prolonged exposure to
carcinogenscarcinogens
 DiverticulaeDiverticulae

7. Barrett’s Oesophagus
(Columnar Cells lining the
Oesophagus)
 Condition as a result ofCondition as a result of
GERDGERDadenocarcinomaadenocarcinoma

8. PATHOLOGY
 Cell typesCell types -Sq. Cell carcinoma - Commonest-Sq. Cell carcinoma - Commonest
- Adenocarcinoma-2nd commonest- Adenocarcinoma-2nd commonest
- Sarcomas- Sarcomas
- Choriocarcinoma- Choriocarcinoma
- Malignant melanoma- Malignant melanoma
- lyphomas- lyphomas
- Others rare- Others rare

9. Tumour location
 Commonest site for Sq. Cell Ca.-Commonest site for Sq. Cell Ca.-
middle1/3, 50-60%.middle1/3, 50-60%.
 For Adencarcinoma - commonest site lowerFor Adencarcinoma - commonest site lower
1/31/3

10. MACROSCOPIC APPEARANCE
 Exophytic – protuberantExophytic – protuberant
 UlcerativeUlcerative
 EndophyticEndophytic

11. SPREAD
 Intraoesophageal-more proximalIntraoesophageal-more proximal
 Direct and invading locallyDirect and invading locally
 Lymphatic-more adenocarcinomaLymphatic-more adenocarcinoma
 HaematogenousHaematogenous

12. CLINICAL MANIFESTATION
 Dysphagia-luminal obstruction-2/3 of itDysphagia-luminal obstruction-2/3 of it
-Solids first, then liquids-Solids first, then liquids
 Hoarseness of voice-recurrent laryngeal nerveHoarseness of voice-recurrent laryngeal nerve
involved.involved.
 Back pain-prevertabral fascia involvedBack pain-prevertabral fascia involved
 Cough-aspiration or fistulaCough-aspiration or fistula
 CachexiaCachexia
 HepatomegallyHepatomegally
 JaundiceJaundice
 LymphadenopathyLymphadenopathy

13. INVESTIGATIONS
 Barium swallowBarium swallow
 Oesophageal brushing-Cystology-UsuallyOesophageal brushing-Cystology-Usually
for screeningfor screening
 Oesophagoscopy + biopsyOesophagoscopy + biopsy
 CT. Scan-work up & staging of diseaseCT. Scan-work up & staging of disease
 MRI-more expensive than CTMRI-more expensive than CT

14. Ba swallow

15. Ba….

16. INVESTIGATIONS
Cont.
 Endoscopy u/s (EUS-Asses tumourEndoscopy u/s (EUS-Asses tumour
penetration & LN involvement. limitation-penetration & LN involvement. limitation-
may not manage to pass probe throughmay not manage to pass probe through
lesion.lesion.
 Bronchoscopy-midoesophagusBronchoscopy-midoesophagus
-Bulge posterior trachea.-Bulge posterior trachea.

17. Endoscopy

18. INVESTIGATIONS
Cont.
- Tumour invasion- Tumour invasion
- Tracheo-oesophageal fistula- Tracheo-oesophageal fistula

19. STAGING
 TNMTNM

20. POSITRON
 Positron emission tomography (PET)-ReliesPositron emission tomography (PET)-Relies
on abnormal glucose uptake by malignanton abnormal glucose uptake by malignant
cells to produce computer generatedcells to produce computer generated
images.images.

21. TREATMENT
 Oesophagectomy + conduit placementOesophagectomy + conduit placement
a. Stomach-rich blood supplya. Stomach-rich blood supply
b. Only one anastomosisb. Only one anastomosis
c. Reaches neck easilyc. Reaches neck easily
d No special preop prep. neededd No special preop prep. needed
 JejunumJejunum
 ColonColon

22. RADIOTHERAPY
 As primary therapy-high recurrencyAs primary therapy-high recurrency
 As adjuvant therapy, better outcomeAs adjuvant therapy, better outcome

23. CHEMOTHERAPY
 5-fu ) As single or5-fu ) As single or
 Cisplatin] combined agentsCisplatin] combined agents

24. PALLIATIVE MEASURES
 Dilatation-Duration of its effect shortDilatation-Duration of its effect short
 Intubation or stentsIntubation or stents

25. COMPILCATIONS
 Perforation of oesophagusPerforation of oesophagus
 Tube migrationTube migration
 AspirationAspiration
 HaemorrhageHaemorrhage
 ObstructionObstruction
 Pressure necrosisPressure necrosis

26. ELECTROCAUTERY
 Injection of tumour with chemicals to cause tumourInjection of tumour with chemicals to cause tumour
necrosisnecrosis
 Laser.Laser.