Carcinoma of the esophagus is a cancer that develops in the lining of the esophagus. There are two main types - squamous cell carcinoma and adenocarcinoma. Risk factors include age, tobacco, alcohol, and conditions like Barrett's esophagus. Symptoms include difficulty swallowing. Diagnosis involves endoscopy with biopsy. Staging uses TNM classification and imaging tests. Treatment depends on stage but may include surgery to remove part of the esophagus, chemotherapy, radiation therapy, or photodynamic therapy. Prognosis depends on stage, with 5-year survival rates of 15-25% for localized disease.

1. CARCINOMA
OESOPHAGUS
Md-3
16/12/2020

2. CARCINOMA OESOPHAGUS
• A disease in which cells in the lining of the
esophagus grow uncontrollably and form a
tumor.
• Carcinoma oesophagus is common in China,
South Africa and Asian countries.
• It is 6th most common cancer in the world.
• It is less than 1% of all cancers. It is 7% of all GI
malignancies.
• It is less common in America and European
countries.

3. • When patient presents with dysphagia, often it is
fairly advanced and inoperable and only palliation
is the possibility.
• But then surgery is the treatment of choice in early
growths.
Types of Esophageal Cancer;
• Two major types of esophageal cancer: squamous
cell carcinoma and adenocarcinoma
• Squamous cell carcinoma starts in squamous cells
that line the esophagus and usually develops in
the upper and middle part of the esophagus

4. • Adenocarcinoma begins in the glandular tissue
in the lower part of the esophagus at the junction
between the esophagus and the stomach
• Treatment is similar for both of these types
• Rare tumors of the esophagus occur in less than
1% of cases and include small cell
neuroendocrine cancer, lymphoma, and
sarcoma

5. What are the Risk Factors for
Esophageal Cancer;
• Age
• Gender
• Race
• Tobacco
• Alcohol
• Barrett’s esophagus, a condition that can
develop in people with chronic
gastroesophageal reflux disease (GERD) or
esophagitis (inflammation of the esophagus)
• Diet

6. • Obesity
• Lye ingestion
• Achalasia (a condition when the lower muscular
ring of the esophagus fails to relax during
swallowing of food)

7. Pathology;
• Common in:
Middle third—50%.
Lower third—33%.
Upper third—17%.
• Lower 3 cm of oesophagus is lined by columnar
epithelium and so adenocarcinoma is common
here.
• Barrett’s columnar metaplasia which occurs in
lower third of oesophagus is also more prone for
adenocarcinoma.
• Squamous cell carcinoma is commonest type in
India and Asian countries.

8.  How do you stage carcinoma esophagus?
 Primary tumor—T
 „T1—Tumor invaded to the lamina propria and
submucosa.
 „T2—Tumor invaded to the muscularis propria.
 „T3—Tumor extending to the adventitial coat.
 „T4—Tumor extending to the adjacent
structures.
 Lymph nodes—n
 „n0—no regional lymph node metastasis.
 „n1—Regional lymph node metastasis present.

9. Distant metastasis—M
 „M0—no distant metastasis.
 „M1—Distant metastasis present.
 Endoscopic USG is very helpful to assess the
primary tumor and lymph node spread.
 CT scan is helpful to delineate the lymph node
and distant metastasis.

10. How does the carcinoma esophagus
spreads?
Direct spread ;
• Spread both circumferentially and
vertically.
• The submucosal spread vertically may
form satellite nodules.
• The tumor may invade through the
adventitia and involve the adjacent
structures—trachea, lungs and other
mediastinal structures.

11. Lymphatic spread: May spread to the
regional lymph nodes.
Distant spread:
• Via hematogenous spread to the liver, lungs and
bones. Involvement of celiac
• lymph node from a lesion of intrathoracic
esophagus is regarded as distant metastasis
rather than regional lymph node metastasis.
Similarly involvement of cervical lymph nodes
from intrathoracic esophagus is regarded as
distant metastasis.

12. Clinical Features
• Recent onset of dysphagia is the commonest
feature.
- For the dysphagia to develop, two-third of the lumen
should be occluded.
• Regurgitation.
• Anorexia and loss of weight (severe), cachexia.
• Pain-substernal or in the abdomen.
• Ascites.
• Melena.
• Features of broncho-oesophageal fistula in
carcinoma of upper third oesophagus (30%).

13. • Left supraclavicular lymph nodes may be
palpable.
• Hoarseness of voice due to involvement of
recurrent laryngeal nerve.
• Hiccough, due to phrenic nerve involvement.
• Back pain—due to nodal spread
(paraoesophageal/coeliac nodes).
• Male to female ratio is 3:1. In adenocarcinoma, it
is 15:1.

14. Investigations;
• Barium swallow:
-Shouldering sign and irregular filling defect.
-Rat tail lesion on fluoroscopy is typical.
• Oesophagoscopy—to see the lesion, extent and
type.
• Biopsy—for histological type and confirmation.
• Chest X-ray—to look for aspiration pneumonia
• Bronchoscopy to see invasion in the upper 1/3rd
carcinoma of oesophagus; laryngoscopy to identify
vocal cord palsy.

15. • CT scan (95% accuracy)—to look for local
extension, nodal status,
perioesophageal/diaphragmatic/pericardial(1%)
-vascular infiltration, obliteration of mediastinal
fat and status of tracheobronchial tree in case of
upper third growth.
• Ultrasound abdomen—to look for liver and
lymph nodes status in abdomen
• Laparoscopy: It is useful to see peritoneal
spread, liver spread and nodal spread.
• Blood tests: FBP; ESR; Liver function tests, RFT
and Electrolyte

16. • Oesophageal endosonography—to look for the
involvement of layers of oesophagus, nodes,
cardia and left lobe of the liver.
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) scan

17. TREATMENT MODALITIES
• Treatment depends on stage of cancer
• More than one treatment may be used
• Surgery
• Chemotherapy
• Radiation therapy
• Photodynamic therapy

18. • The most common treatment
• Esophagectomy: removal of part of the esophagus;
remaining portion is connected to the stomach
• Lymph nodes around the esophagus may also be
removed
• Rarely, surgery may also be used to create a new
pathway to the stomach, insert a feeding tube, or
other methods to help a person if unable to eat

19. • CHEMOTHERAPY
• Use of drugs to kill cancer cells
• A combination of medications is often used
• Systemic chemotherapy is delivered through the
bloodstream, targeting cells throughout the body
• Side effects include fatigue, risk of infection,
nausea and vomiting, loss of appetite, and
diarrhea

20. RADIATION THERAPY
• The use of high-energy x-rays to destroy cancer
cells
• Different methods of delivery
• External beam: outside the body
• Internal radiation or brachytherapy: radiation is
given by temporarily inserting a radioactive wire
into the esophagus
• Side effects may include fatigue, mild skin
reactions, upset stomach, and loose bowel
movements

21. • PHOTODYNAMIC THERAPY
• Lasers or light therapy to destroy cancerous
tissue and relieve blockages
• Used in people who cannot or choose not to
receive surgery, radiation therapy or
chemotherapy
• Often used to relieve swallowing problems, not
as a curative therapy

22. REFFRENCES;
• SRB’s manual of surgery 5th edition
• National Cancer Institute
(www.cancer.gov/clinical_trials)
• Bedside clinics in surgery 2nd edition.