Esophageal cancer is most common in central Kenya with a male to female ratio of 3:1, usually occurring in people aged 50-80. It starts as an epithelial disease in the esophagus, a tubular organ with three layers but no protective serosa. The primary types are squamous cell carcinoma and adenocarcinoma. Risk factors include diet, smoking, alcohol, viral infections and gastroesophageal reflux disease. Presentation includes progressive dysphagia, weight loss, and if metastasized, jaundice or liver involvement. Diagnosis involves imaging, endoscopy with biopsy, and staging helps guide management, which may include local excision, resection, chemotherapy or radiotherapy depending on tumor extent

1. ESOPHAGEAL CANCER
Dr Winston Makanga, M.B.Ch.B., M.Med. (Surg)
Consultant General and Laparoscopic Surgeon

2. Outline
• Pathology
• Etiology
• Presentation
• Investigation
• Management

3. Incidence

4. Kenya
• Central rift
• Western
• Central
• M:F = 3:1
• Age 50-80

5. Anatomy
• Tubular organ
• 3 layers, No serosa
• 3 divisions
• Lymphatics in the submucosa

6. Pathology
• Primary
• Sq. cell carcinoma
• Adenocarcinoma
• Leiyomyosarcoma
• Secondary
• Broncogenic ca
• Lung cancer
• Spread
• Local
• Nodal
• Distant
• Starts as epithelial disease
• In a closely packed space with major surrounding organs
• Lack of serosal covering means no barrier
• Dysphagia affects nutrition early
• Metastasis are not main cause of death

7. • Ulcerative
• Exophytic/polypoid
• Infiltrative
• 20% upper
• 50% middle
• 30% lower

8. Etiology/risk factors
• Diet
• High fibre
• Smoked fish
• Hot fluids/feeds
• Phytates
• Alcohol
• Smoking
• Viral esophagitis
• Plummer-Vinson
• GERD/Barrets

9. Presentation
• Assymptomatic
• Progressive Dysphagia
• Cachexia (wasting, weakness, anemia)
• If metastasis present
• Nodes
• Jaundice
• Hepatomegaly and ascites

10. Investigation
• Hemogram, UEC, LFT
• Contrast radiography
• Endoscopy with biopsy
• CT scan
• Endoscopic ultrasound
• Others
• PET scan
• Bronchoscopy
• Diagnostic laparoscopy

15. Staging
1. Small local disease
2. Large local disease
3. Local infiltration
or Nodal disease
4. Distant spread

16. Differentials
• All other causes of dysphagia
• Benign strictures
• Webs
• Achalasia
• Motility disorders

17. Management
• Local excisions
• Endoscopic mucosal resection
• Endoscopic submucosal dissection
• Curative resection (+NACT)
• Trans-thoracic
• Trans-hiatal
• Palliation
• Endoluminal stenting
• Laser recanalizaton
• Chemotherapy
• Radiotherapy
Must assess fitness for surgery
Tumor should be local

19. Review
• Pathology
• Etiology
• Presentation
• Investigation
• Management

20. Thanks