ANATOMY OF ESOPHAUS, EVALUATION & MANAGEMENT OF CA ESOPHAGUS,

1. CARCINOMA
ESOPHAGUS
Presented by : Dr. MK Tiwari

2. EMBRYOLOGY

3. EMBRYOLOGY

4. EMBRYOLOGY

5. ANATOMY

6. ANATOMY

7. ANATOMY

8. ANATOMY

10. ANATOMY
Inferior thyroid artery
Tracheobronchial &
bronchoesophageal
artey
Esophageal artery
Lt Gastric artery
Splenic artery

11. ANATOMY

12. ANATOMY

13. ANATOMY

14. ANATOMY

15. ANATOMY

16. ANATOMY

17. EPIDEMIOLOGY
• 6th leading cause of
cancer death
• 1% total malignancy
and 5-10% of GI
malignancy
• Most prevalent in Asia
& SE Asia.
• Most common
histological type-
Squamous Cell
Carcinoma &
Adenocarcinoma

18. RISK FACTORS
• Maingot's Abdominal Operations. 13th edition

19. PATHOGENESIS

20. BARRETTS
ESOPHAGUS
• Normal Squamous epithelium replaced by
Columnar epithelium
• Endoscopy should be performed on patients
with severe symptoms of GERD, family
history of Barrett’s esophagus or esophageal
cancer
• location, length, and circumferential
involvement should be characterized in
accordance with the Prague classification and
mucosal nodules should be carefully
documented.

21. BARRETTS
ESOPHAGUS
• Normal Squamous epithelium replaced by
Columnar epithelium
• Endoscopy should be performed on patients
with severe symptoms of GERD, family
history of Barrett’s esophagus or esophageal
cancer
• location, length, and circumferential
involvement should be characterized in
accordance with the Prague classification and
mucosal nodules should be carefully
documented.

22. DIAGNOSIS BE

24. PATHOGENESIS BE

25. HEREDITARY CANCER
PREDISPOSITION
SYNDROME
• Tylosis
• Familial Barrett’s Esophagus
• Bloom Syndrome
• Fanconis Anemia

26. HEREDITARY CANCER
PREDISPOSITION
SYNDROME

27. CLINICAL FEATURES
• Progressive Dysphagia
• Reflux symptoms
• Fatigue
• Retrosternal Pain
• Anemia
• Hoarseness
• Tracheoesophageal Fistula

29. DIAGNOSIS &
STAGING

33. PRINCIPALS OF
ENDOSCOPIC SATGING AND
THERAPY
• Diagnosis
• Staging
• Primary treatment
• Treatment of symptoms
• Follow up surveillance

35. PET CT
• Can detect 15-20%
metastasis not
detected in CT and
EUS
• Low accuracy in
detecting nodal
disease
• Follow up response to
chemo & radiotherapy

37. DIAGNOSIS &
STAGING

38. DIAGNOSIS &
STAGING

39. DIAGNOSIS &
STAGING

40. DIAGNOSIS &
STAGING

41. TUMOR MARKERS
• HER2
• dMMR
• MSI-H
• PD-L1
• H2 RLN
• WDR 66
• PLA2G2A
World Journal of Gastrointestinal Oncology. 2014 May 15; 6(5): 112–120.Published online 2014 May 15.

42. MANAGEMENT
CA ESOPHAGUS
SURGERY CHEMOTHERAPY
RADIATION

57. PRINCIPLES OF
SURGERY• Clinical staging prior to surgery
• Tumor should be classified as per Siewarts classification
• Diagnostic Lap in Siewert II & III to assess occult mets
• In patients with advanced tumors, clinical T3 or N+ disease
should be considered for laparoscopic staging with peritoneal
washings.
• Cervical or cervicothoracic esophageal carcinomas <5 cm from
the cricopharyngeus: definitive chemoradiation.
• Resectable Esophageal Carcinoma
• Unresectable Esophageal Carcinoma

58. • Transthoracic Esophegectomy
• Ivor Lewis Approach(Rt
thoracotomy+Laparotomy+Thoracic Anastomosis)
• McKewon Approach(Rt
thoracotomy+Laparotomy+Cervical anastomosis)
• Transhiatal Esophagectomy
• Thoraco-abdominal Esophagectomy
• Minimally invasive Esophagectomy
PRINCIPLES OF
SURGERY

59. IVOR LEWIS
APPROACH

76. TRANS-HIATAL
APPROACH

92. PRINCIPLES OF
SURVEILLANCE

93. PRINCIPLES OF
SURVILLANCE

94. THANK YOU