This document discusses malignant disorders of the esophagus, specifically esophageal cancer. It provides details on the two main types - squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma is still more common worldwide, while adenocarcinoma is becoming more prevalent in the US and Europe. Risk factors include tobacco and alcohol consumption as well as conditions like Barrett's esophagus. Symptoms typically include dysphagia and weight loss. Diagnosis involves endoscopy with biopsy as well as imaging studies like CT and PET scans to stage the cancer.
The stomach J-shaped. It has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.
Blood supply
The left gastric artery
Right gastric artery
Right gastro-epiploic artery
Left gastro-epiploic artery
Short gastric arteries
Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Also called gastric cancer, the disease usually grows slowly over many years.
It could be:
malignant or benign
primary or secondary
The stomach J-shaped. It has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.
Blood supply
The left gastric artery
Right gastric artery
Right gastro-epiploic artery
Left gastro-epiploic artery
Short gastric arteries
Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Also called gastric cancer, the disease usually grows slowly over many years.
It could be:
malignant or benign
primary or secondary
Sites of the highest risk are the duodenum, for adenocarcinomas, and the ileum, for carcinoids and lymphomas.
In industrialized countries, small bowel cancers are predominantly adenocarcinomas;
In developing countries, lymphomas are much more common.
The incidence of small bowel cancer rises with age and has generally been higher among males than among females.
The risk factors for small bowel cancer include
Dietary factor
Cigarette smoking,
Alcohol intake,
Medical conditions -Crohn's disease, familial adenomatous polyposis, cholecystectomy, peptic ulcer disease, and cystic fibrosis.
The protective factors may include rapid cell turnover, a general absence of bacteria, an alkaline environment, and low levels of activating enzymes of precarcinogens.
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
Carcinoma esophagus is a lethal disease and carries poor prognosis.The diagnosis is usually delayed and over all 5yrs survival is less than 15% In this presentation I have discussed carcinoma esophagus - its pathology, clinical features, investigations and treatment in nutshell
Sites of the highest risk are the duodenum, for adenocarcinomas, and the ileum, for carcinoids and lymphomas.
In industrialized countries, small bowel cancers are predominantly adenocarcinomas;
In developing countries, lymphomas are much more common.
The incidence of small bowel cancer rises with age and has generally been higher among males than among females.
The risk factors for small bowel cancer include
Dietary factor
Cigarette smoking,
Alcohol intake,
Medical conditions -Crohn's disease, familial adenomatous polyposis, cholecystectomy, peptic ulcer disease, and cystic fibrosis.
The protective factors may include rapid cell turnover, a general absence of bacteria, an alkaline environment, and low levels of activating enzymes of precarcinogens.
Colorectal cancer is most common GI cancer
The rectum is the most frequent site involved
Adenoma-carcinoma sequence: Arises from adenoma in stepwise progression
Carcinoma esophagus is a lethal disease and carries poor prognosis.The diagnosis is usually delayed and over all 5yrs survival is less than 15% In this presentation I have discussed carcinoma esophagus - its pathology, clinical features, investigations and treatment in nutshell
5-YEAR SURVIVAL OF UPPER THIRD ESOPHAGEAL CANCER PATIENTS WAS SIGNIFICANTLY SUPERIOR IN COMPARISON WITH MIDDLE AND LOWER THIRD ESOPHAGEAL CANCER PATIENTS AFTER RADICAL SURGERY AND STRONGLY DEPENDED ON PHASE TRANSITION EARLY-INVASIVE CANCER, LYMPH NODE METASTASES, CELL RATIO FACTORS AND ADJUVANT CHEMOIMMUNORADIOTHERAPY
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
2. Esophageal CancerEsophageal Cancer
88thth
commonest cancercommonest cancer
Nepal : 3.79/ 100 000 -Nepal : 3.79/ 100 000 -
Most esophageal tumors are malignant, fewerMost esophageal tumors are malignant, fewer
than 1% are benignthan 1% are benign
High prevalence areas are Asia, Africa andHigh prevalence areas are Asia, Africa and
northern Francenorthern France
13,000 new patients in the United States13,000 new patients in the United States
3. Esophageal CancerEsophageal Cancer
Most patients still present with locally advancedMost patients still present with locally advanced
(stage T 3 and/or N 1 ) disease(stage T 3 and/or N 1 ) disease
Two types of histologyTwo types of histology
Squamous cellSquamous cell
Adeno CaAdeno Ca
4. Esophageal CancerEsophageal Cancer
Adeno Ca now becoming predominantAdeno Ca now becoming predominant
Squamous cell still persists in patients with theSquamous cell still persists in patients with the
usual risk factors for other aerodigestive tractusual risk factors for other aerodigestive tract
carcinomas.carcinomas.
5. Risk FactorsRisk Factors
CONSUMPTION OF:CONSUMPTION OF:
Tobacco, Alcohol (5 times each)Tobacco, Alcohol (5 times each)
UNDER-CONSUMPTION OF:UNDER-CONSUMPTION OF:
Fruits, Fresh meat, Riboflavin. Beta-carotene,Fruits, Fresh meat, Riboflavin. Beta-carotene,
Vitamin C, Magnesium, Vegetables, Fresh fish,Vitamin C, Magnesium, Vegetables, Fresh fish,
Niacin, Vitamin A, Vitamin B complex, ZincNiacin, Vitamin A, Vitamin B complex, Zinc
8. Squamous Cell CarcinomaSquamous Cell Carcinoma
95% of esophageal cancer worldwide95% of esophageal cancer worldwide
Commonly 7Commonly 7thth
decade of life, 1.5-3 times moredecade of life, 1.5-3 times more
common in mencommon in men
Thought to occur from prolonged exposure ofThought to occur from prolonged exposure of
esophageal mucosa to noxious stimuli in personsesophageal mucosa to noxious stimuli in persons
with a genetic predisposition to the disease.with a genetic predisposition to the disease.
9. Squamous Cell CarcinomaSquamous Cell Carcinoma
Histologically, characterized by invasive sheetsHistologically, characterized by invasive sheets
of cells that run together and are polygonal, oval,of cells that run together and are polygonal, oval,
or spindle-shaped with a distinct or raggedor spindle-shaped with a distinct or ragged
stromal-epithelial interface.stromal-epithelial interface.
Located mainly in the thoracic esophagus,Located mainly in the thoracic esophagus,
approximately 60% of these tumors are found inapproximately 60% of these tumors are found in
the middle third and about 30% in the distalthe middle third and about 30% in the distal
third.third.
10. Squamous Cell CarcinomaSquamous Cell Carcinoma
Four major gross pathologic presentations:Four major gross pathologic presentations:
(1) fungating: predominantly intraluminal growth(1) fungating: predominantly intraluminal growth
with surface ulceration and extreme friabilitywith surface ulceration and extreme friability
that frequently invades mediastinal structures;that frequently invades mediastinal structures;
(2) ulcerating: flat-based ulcer with slightly raised(2) ulcerating: flat-based ulcer with slightly raised
edges; hemorrhagic, friable with surroundingedges; hemorrhagic, friable with surrounding
indurationinduration
11. Squamous Cell CarcinomaSquamous Cell Carcinoma
(3) infiltrating: a dense, firm, longitudinal and(3) infiltrating: a dense, firm, longitudinal and
circumferential intramural growth patterncircumferential intramural growth pattern
(4) polypoid: intraluminal polypoid growth with a(4) polypoid: intraluminal polypoid growth with a
smooth surface on a narrow stalk (fewer thansmooth surface on a narrow stalk (fewer than
5% of cases)5% of cases)
A 5-year survival of 70% is associated with theA 5-year survival of 70% is associated with the
polypoid tumor compared with a less than 15%polypoid tumor compared with a less than 15%
5-year survival for all other types5-year survival for all other types
12. AdenocarcinomaAdenocarcinoma
Most common cell type of esophageal cancer inMost common cell type of esophageal cancer in
the United States and Europe.the United States and Europe.
Adenocarcinoma arises from the superficial andAdenocarcinoma arises from the superficial and
deep glands of the esophagus, mainly in thedeep glands of the esophagus, mainly in the
lower third of the esophagus, especially near thelower third of the esophagus, especially near the
gastroesophageal junction.gastroesophageal junction.
13. AdenocarcinomaAdenocarcinoma
Whites are at four times greater risk than blacksWhites are at four times greater risk than blacks
Men have an eightfold higher risk than women.Men have an eightfold higher risk than women.
In the US and Europe, frequency of this tumorIn the US and Europe, frequency of this tumor
is increasing faster than any other cancer.is increasing faster than any other cancer.
14. AdenocarcinomaAdenocarcinoma
Esophageal adenocarcinoma may have one ofEsophageal adenocarcinoma may have one of
three origins:three origins:
• malignant degeneration of metaplastic columnarmalignant degeneration of metaplastic columnar
epithelium (Barrett's mucosa)epithelium (Barrett's mucosa)
• heterotopic islands of columnar epitheliumheterotopic islands of columnar epithelium
• the esophageal submucosal glands.the esophageal submucosal glands.
15. AdenocarcinomaAdenocarcinoma
Gastric adenocarcinoma may also involve the esophagusGastric adenocarcinoma may also involve the esophagus
secondarily.secondarily.
Gastroesophageal junction tumors arise initially as flat or raisedGastroesophageal junction tumors arise initially as flat or raised
patches of mucosa. They may subsequently ulcerate and becomepatches of mucosa. They may subsequently ulcerate and become
large (up to 5 cm) nodular masses.large (up to 5 cm) nodular masses.
Tumor size is related to prognosis. For tumors smaller than 5Tumor size is related to prognosis. For tumors smaller than 5
cm, 40% are localized, 25% have spread beyond the esophagus,cm, 40% are localized, 25% have spread beyond the esophagus,
and 35% have metastasized or are unresectable. For tumors thatand 35% have metastasized or are unresectable. For tumors that
are more than 5 cm in length, 10% are localized, 15% haveare more than 5 cm in length, 10% are localized, 15% have
invaded mediastinal structures, and 75% have metastasized.invaded mediastinal structures, and 75% have metastasized.
16. Rare esophageal cancersRare esophageal cancers
Anaplastic small cell (oat cell) carcinoma arise inAnaplastic small cell (oat cell) carcinoma arise in
the esophagus from same argyrophilic cellsthe esophagus from same argyrophilic cells
found in the lung.found in the lung.
Adenoid cystic esophageal carcinomaAdenoid cystic esophageal carcinoma
Primary malignant melanoma of esophagusPrimary malignant melanoma of esophagus
Carcinosarcoma, features of SSC and malignantCarcinosarcoma, features of SSC and malignant
spindle cell sarcoma.spindle cell sarcoma.
17. Clinical FindingsClinical Findings
Dysphagia in more than 90% of patients withDysphagia in more than 90% of patients with
esophageal canceresophageal cancer
Nonspecific retrosternal discomfortNonspecific retrosternal discomfort
IndigestionIndigestion
Weight lossWeight loss
PainPain
Regurgitation, resp symptoms, hoarsenessRegurgitation, resp symptoms, hoarseness
18. Clinical FindingsClinical Findings
SymptomSymptom PercentPercent
DysphagiaDysphagia 87-9587-95
Weight lossWeight loss 42-7142-71
Vomiting or regurgitationVomiting or regurgitation 29-4529-45
PainPain 20-4620-46
Cough or hoarsenessCough or hoarseness 7-267-26
DyspneaDyspnea 55
19. Clinical FindingsClinical Findings
Careful examination of cervical andCareful examination of cervical and
supraclavicular lymph nodessupraclavicular lymph nodes
FNA or excisional biopsy for diagnosisFNA or excisional biopsy for diagnosis
Evaluate for abdominal masses and liverEvaluate for abdominal masses and liver
nodularitynodularity
Labwork, imaging studiesLabwork, imaging studies
22. Imaging StudiesImaging Studies
Computed tomography (CT) of the chest andComputed tomography (CT) of the chest and
upper abdomen is the standard radiographicupper abdomen is the standard radiographic
technique for staging esophageal cancer.technique for staging esophageal cancer.
Normal esophageal wall thickness 5mmNormal esophageal wall thickness 5mm
Regional adenopathyRegional adenopathy
Metastasis to lung, liver, adrenal, or distantMetastasis to lung, liver, adrenal, or distant
nodesnodes
FNA biopsy for tissue diagnosisFNA biopsy for tissue diagnosis
23. Imaging StudiesImaging Studies
Positron emission tomography (PET)Positron emission tomography (PET)
Does not rely on anatomic or structuralDoes not rely on anatomic or structural
distortion for detecting malignancydistortion for detecting malignancy
PET is 88% sensitive, 93% specific, and 71 toPET is 88% sensitive, 93% specific, and 71 to
91% accurate for identifying distant metastasis91% accurate for identifying distant metastasis
24. Imaging StudiesImaging Studies
Cellular FDG uptake is not specific for tumorsCellular FDG uptake is not specific for tumors
and that areas of inflammation often predisposeand that areas of inflammation often predispose
to false-positive resultsto false-positive results
MRI has a 56 to 74% accuracy in detectingMRI has a 56 to 74% accuracy in detecting
lymph node metastaseslymph node metastases
25. Endoscopic UltrasoundEndoscopic Ultrasound
Method of choice to determine depth of tumorMethod of choice to determine depth of tumor
invasion and regional nodal disease andinvasion and regional nodal disease and
involvement of adjacent structures, with aninvolvement of adjacent structures, with an
overall accuracy to 92%overall accuracy to 92%
A significant error associated with endoscopicA significant error associated with endoscopic
ultrasound T staging is to overstage 7 to 11% ofultrasound T staging is to overstage 7 to 11% of
early diseaseearly disease
27. TNM StagingTNM Staging
T: PRIMARY TUMORT: PRIMARY TUMOR
• T 0 No evidence of a primary tumorT 0 No evidence of a primary tumor
• T is Carcinoma in situ (high-grade dysplasia)T is Carcinoma in situ (high-grade dysplasia)
• T 1 Tumor invading the lamina propria, muscularis mucosae,T 1 Tumor invading the lamina propria, muscularis mucosae,
or submucosa but not breaching the boundary betweenor submucosa but not breaching the boundary between
submucosa and muscularis propriasubmucosa and muscularis propria
• T 2 Tumor invading muscularis propria but not breaching theT 2 Tumor invading muscularis propria but not breaching the
boundary between muscularis propria and periesophagealboundary between muscularis propria and periesophageal
tissuetissue
• T 3 Tumor invading periesophageal tissue but not adjacentT 3 Tumor invading periesophageal tissue but not adjacent
structuresstructures
• T 4 Tumor invading adjacent structuresT 4 Tumor invading adjacent structures
28. TNM StagingTNM Staging
N: REGIONAL LYMPH NODESN: REGIONAL LYMPH NODES
N 0 No regional lymph node metastasisN 0 No regional lymph node metastasis
N 1 Regional lymph node metastasisN 1 Regional lymph node metastasis
M: DISTANT METASTASISM: DISTANT METASTASIS
M 0 No distant metastasisM 0 No distant metastasis
M 1 Distant metastasisM 1 Distant metastasis
29. Stage GroupingStage Grouping
Stage 0Stage 0 T 0 N 0T 0 N 0
T is N 0 M0T is N 0 M0
Stage IStage I T 1 N 0 M0T 1 N 0 M0
Stage IIStage II IIAIIA T 2 N0 M 0T 2 N0 M 0
T 3 N 0 M0T 3 N 0 M0
IIBIIB T 1 N 1 M0T 1 N 1 M0
T 2 N 1 M0T 2 N 1 M0
30. Stage GroupingStage Grouping
Stage IIIStage III T 3 N 1 M0T 3 N 1 M0
T 4 any N M 0T 4 any N M 0
Stage IVStage IV any T any N M 1any T any N M 1
31. 5 Year Survival5 Year Survival
Stage IStage I 50-55%50-55%
Stage IIAStage IIA 15-35%15-35%
Stage IIBStage IIB 15-27%15-27%
Stage IIIStage III 4-15%4-15%
Stage IVStage IV 0-2%0-2%
34. Treatment OptionsTreatment Options
Curative resection?Curative resection?
Ivor – LewisIvor – Lewis
Mc KwoenMc Kwoen
TranshiatalTranshiatal
Minimally invasive esophagectomyMinimally invasive esophagectomy
Mid esophagus approached from rightMid esophagus approached from right
Distal esophagus from leftDistal esophagus from left