Cancer of the Esophagus

1. Cancer of the Esophagus
Prepared by: Arpana Bhusal
BNS

2. Risk Factors
• Tobacco use.
• Heavy alcohol use.
• Barrett esophagus
• Older age.
• Being male.
• Being African-American.

3. Two most common forms of esophageal
cancer are named for the type of cells that
become malignant
Squamous cell carcinoma forms in squamous
cells, the thin, flat cells lining the esophagus.
This cancer is most often found in the upper
and middle part of the esophagus
Adenocarcinoma begins
in glandular (secretory) cells. Glandular cells in
the lining of the esophagus produce and
release fluids such as mucus.
Adenocarcinomas usually form in the lower part
of the esophagus, near the stomach.

4. Squamous Cancer
• Now only accounts for less than
30% of cases in the US
• Tobacco and Alcohol are the
major risk factors

5. Adenocarcinoma
• now most common type in the US, esp in
white men
• Obesity and a high Body Mass Index
(BMI) are high risk factors, very high BMI
risk is 7.6 higher
• GERD (gastroesophageal reflux) high
risk
• Barrett’s esophagus increases the risk to
30 – 60 higher

6. Barrett’s Esophagus – Columnar Cells Extend Above the GE Junction

7. Barrett’s Esophagus
• Replacement of normal esophageal lining
cells (stratified squamous) with cells that
predispose to cancer (metaplastic columnar
epithelium)
• Due to chronic GERD (gastroesophageal
reflux)
• Median age at diagnosis is 55y
• Predisposed to getting adenocarcinoma of
the lower esophagus

8. Signs and Symptoms of
Esophagus Cancer
• Difficulty and pain with swallowing
• Pressure or burning in the chest
• Indigestion or heartburn
• Vomiting
• Frequent choking on food
• Unexplained weight loss
• Coughing or hoarseness
• Pain behind the breastbone or in the
throat

12. Epithelial
Lamina Propria
Basement
Membrane
Muscular mucosa
Layers of the Mucosa
T is = epithelial only
T1a = through the
basement membrane
into lamina propria or
muscularis mucosa
T1b = into submucosa
Submucosa

13. T = Tumor

14. N = Nodes , M =
Metastases

15. Stage 5 Y 10 Y
I 62% 51%
Ia 71% 58%
Ib 60% 50%
II 47% 37%
IIa 53% 43%
IIb 42% 33%
III 20% 16%
IIIa 25% 20%
IIIb 17% 14%
IIIc 14% 12%
Squamous Cancer
Survival after Esophagectomy

16. Adenocarcinoma
Survival after Esophagectomy
Stage 5y 10Y
I 73% 61%
Ia 77% 67%
Ib 63% 51%
II 41% 33%
IIa 50% 37%
IIb 40% 30%
III 20% 17%
IIIa 25% 20%
IIIb 17% 14%
IIIc 13% 12%

17. Spread:
(1) Direct: (main method): to the surrounding
(2) Lymphatic: mainly in a downward direction.
** Cervical esophagus → lower deep cervical L.N.
** Thoracic esophagus → para-oesophageal &
tracheo-bronchial lymph nodes
** Abdominal esophagus → lymph nodes along the
lesser curvature of the stomach → coeliac axis
L.N.
(3) Blood (rare):
Liver, lung, bone, brain

18. Inoperable cancer esophagus
Non-obstructed Obstructed
Palliative chemo-
radiotherapy
1. LASER tunneling with endoluminal
stenting
2. Photodynamic therapy
3. Intubation
4. Jejunostomy or Gastrostomy for feeding

19. Thank You