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Management Guideline in
Esophageal cancer
Dr Atul Gupta
DM Resident
Radiotherapy & Oncology
AIIMS JODHPUR
HISTOLOGY OF ESOPHAGEAL CANCER-
 Squamous Cell Carcinoma- approx. one third of esophageal cancer
approx. 60% in middle third while 30% in distal third and 10% in proximal third
associated with widespread submucosal lymphatic dissemination
 Adenocarcinoma- arise in context of Barrett esophagus, occurs in distal third
 Rare Varieties- SCC with sarcomatous features, adenoid cystic ca, mucoepidermoid cancer, Adeno-squamous ca, small
cell carcinoma, leiomyosarcoma, lymphoma
 No significant survival difference noted in patients with adenocarcinoma as compared with SCC.
CLINICAL PRESENTATION-
 Cervical Esophageal Cancer- dysphagia and weight loss (Most common complaints)
hoarseness of voice (11-24%)
 Thoracic Esophageal Cancer- Asymptomatic ( 6-10%)
progressive dysphagia a/w weight loss
odynophagia ( 20%)
other symptoms include hoarseness of voice, IDA, symptoms of distant metastasis
 Adenocarcinoma – usually metastasize to intra-abdominal sites (liver and peritoneum)
 SCC- usually intra-thoracic metastasis
DIAGNOSTIC EVALUATION-
• EUS is superior to CT scans in both T and N staging of esophageal cancer.
• The overall accuracy for T staging is approximately 85%, and for N staging, it is approximately
75%.
• EUS is highly operator dependent and is limited in its ability to accurately define relatively
superficial lesions as either T1 or T2
• CT scans are highly accurate
(approaching 100%) at detecting liver
or lung metastases and suggesting
peritoneal carcinomatosis (e.g.,
ascites, omental infiltration,
peritoneal tumor studding).
• Accuracy for detecting aortic
involvement or tracheobronchial
invasion exceeds 90%.
• A CT scan is inaccurate in
determining T stage and N stage.
In the detection of distant metastases, an
FDG-PET scan is superior to CT, with a
sensitivity, specificity, and accuracy all in
the range of 80% to 90%
TREATMENT MODALITIES FOR ESOPHAGEAL CANCER -
A)Single Modality :
a) Endoscopic
b) Surgical Resection
c) Radiation Therapy
d) Chemotherapy
B) Combined Modality
Management Guideline for Esophageal SCC
Management Guideline for Esophageal
Adenocarcinoma
Management Guideline in Esophageal cancer.pptx
Management Guideline in Esophageal cancer.pptx
Management Guideline in Esophageal cancer.pptx
Management Guideline in Esophageal cancer.pptx
Management Guideline in Esophageal cancer.pptx
Management Guideline in Esophageal cancer.pptx
Management Guideline in Esophageal cancer.pptx
Management Guideline in Esophageal cancer.pptx
Management Guideline in Esophageal cancer.pptx
Management Guideline in Esophageal cancer.pptx

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Management Guideline in Esophageal cancer.pptx

  • 1. Management Guideline in Esophageal cancer Dr Atul Gupta DM Resident Radiotherapy & Oncology AIIMS JODHPUR
  • 2.
  • 3. HISTOLOGY OF ESOPHAGEAL CANCER-  Squamous Cell Carcinoma- approx. one third of esophageal cancer approx. 60% in middle third while 30% in distal third and 10% in proximal third associated with widespread submucosal lymphatic dissemination  Adenocarcinoma- arise in context of Barrett esophagus, occurs in distal third  Rare Varieties- SCC with sarcomatous features, adenoid cystic ca, mucoepidermoid cancer, Adeno-squamous ca, small cell carcinoma, leiomyosarcoma, lymphoma  No significant survival difference noted in patients with adenocarcinoma as compared with SCC.
  • 4. CLINICAL PRESENTATION-  Cervical Esophageal Cancer- dysphagia and weight loss (Most common complaints) hoarseness of voice (11-24%)  Thoracic Esophageal Cancer- Asymptomatic ( 6-10%) progressive dysphagia a/w weight loss odynophagia ( 20%) other symptoms include hoarseness of voice, IDA, symptoms of distant metastasis  Adenocarcinoma – usually metastasize to intra-abdominal sites (liver and peritoneum)  SCC- usually intra-thoracic metastasis
  • 5. DIAGNOSTIC EVALUATION- • EUS is superior to CT scans in both T and N staging of esophageal cancer. • The overall accuracy for T staging is approximately 85%, and for N staging, it is approximately 75%. • EUS is highly operator dependent and is limited in its ability to accurately define relatively superficial lesions as either T1 or T2
  • 6. • CT scans are highly accurate (approaching 100%) at detecting liver or lung metastases and suggesting peritoneal carcinomatosis (e.g., ascites, omental infiltration, peritoneal tumor studding). • Accuracy for detecting aortic involvement or tracheobronchial invasion exceeds 90%. • A CT scan is inaccurate in determining T stage and N stage. In the detection of distant metastases, an FDG-PET scan is superior to CT, with a sensitivity, specificity, and accuracy all in the range of 80% to 90%
  • 7.
  • 8. TREATMENT MODALITIES FOR ESOPHAGEAL CANCER - A)Single Modality : a) Endoscopic b) Surgical Resection c) Radiation Therapy d) Chemotherapy B) Combined Modality
  • 9.
  • 10. Management Guideline for Esophageal SCC
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20. Management Guideline for Esophageal Adenocarcinoma