This document discusses cancer of the esophagus, including the two main types (squamous cell carcinoma and adenocarcinoma), risk factors, diagnosis, pathophysiology, clinical manifestations, and management. Management may include radiation therapy, chemotherapy, photodynamic therapy, and maintaining nutrition, with the goals of inhibiting tumor growth, relieving symptoms, and improving quality of life. Early detection of Barrett's esophagus allows for endoscopic surveillance that can detect cancer early.

1. Oesophageal cancer
Cancer of the oesophagus takes the
form of either squamous cell carcinoma
or adenocarcinoma of the oesophageal
mucosa

2. Etiology and risk factors
• The cause is unknown but it is probably
multifaceted
• The major risk factors include:-
Cigarette smoking
Alcohol consumption
HPV has been found in 70% of clients with SCC
of the oesophagus
The greatest risk in AC is Barrett’s oesophagus

3. Etiology and risk factors cont’d
• Other risk factors for AC include:-
Obesity
Ingestion of smoked meats
Poor nutritional intake of vitamin A, C and
minerals such as magnesium, selenium and
zinc

4. Diagnosis
• There are no procedures for screening to
detect the conditionearly
• Once Barrett’s oesophagus are detected, it is
recommend that endoscopic surveillance
every 1 to 3 years be initiated
• Health promotion and maintenance behaviour
involve:-
Limiting or stopping smoking, alcohol,
ingestion of hot food and beverages

5. Pathophysiology
• The oesophagus is lined with squamous
epithelium which is continuous until it reaches
the gastroesophageal junction
• At the junction, columnar tissue lines the
oesophagus
• Most cancers of the oesophagus begin as
slow-growing tissue changes or dysplasia

6. Squamous Cell Carcinoma
• This is frequently found in the proximal or mid
oesophagus
• Cellular changes are usually seen before the
development
• Changes are found more often in smokers
than non smokers
• SCC can be classified as polypoid, ulcerative,
or infilltrative

7. Squamous Cell Carcinoma cont’d
• Infiltrative tumours of the oesophagus expand
locally and rapidly causing thickening and
narrowing of the lumen
• A polypoid mass projects into the lumen
obstructing the lumen if undetected
• Ulcerative lesions are raised and may expand
into the mucosa elevating until obstructive

8. Adenocarcinoma
• Arise from columnar epithelium of the
oesophagus
• The columnar epithelial changes are usually
attributed to Barrett’s oesophagus
• Because the oesophagus has no serosal layer,
tumours are allowed to spread to adjacent
tissue and lymphatic nodes early.

9. Adenocarcinoma cont’d
• The rich lymphatic supply to the mucosa
provides an excellent means for the cancer to
metastasize widely and quickly causing the
tumour to be unresectable
• Common distant metastatic sites are liver,
lung, pleura and kidneys
• Other areas include bone, peritoneum and
brain

10. Clinical manifestation
• Dysphagia- which is progressive
• Odynophagia
• Pain in the epigastric region or sternal area
• Loss of appetite
• Malaise
• Increase in salivation and mucus in the throat
• Nocturnal aspiration
• Regurgitation
Manifestations are usually not apparent until the cancer
involves the circumference of the oesophagus

11. Diagnosis
• Endoscopy with biopsy and cytology
examination is the only definite method of
diagnosing oesopahgeal cancer
• Ultra sound
• CT scan exploratory laparatomy may be used
to visualise and biopsy possible for metastasis

12. Management
• Inhibit tumour growth
Treatment depends on tumour’s location, size,
metastases, and performance status of the client
If it is found in the early stage, treatment is directed
toward cure; unfortunately, it is directed in late
stages when treatment becomes palliative, aimed
specifically at allowing the client to continue to
live longer with good quality of life

13. Radiation therapy
• This can be used alone as a single therapy or
before surgery (neoadjuvant), after surgery
(adjuvant), or concurrently with 5-fluorouracil (5-
FU) by continuous infusion (chemoradiation)
• It reduces tumour size and slows tumour growth
• Because radiation can cause stenosis of the
oesophagus, treatments are ussually
administered over a 6 to 8 weeks to minimise this
effect

14. Chemotherapy
• This may be single or a combination of agents
• The goal is to relieve manifestations and
reduction of tumour size
• Neoadjuvant chemotherapy can facilitate surgical
resection by reducing tumour size and
invasiveness
• Commonly used drugs include:- cisplatin
(Platinol) and 5-fluorouracil (5-FU) docetaxel
(Taxotere), irinotecan (Camptosar)and oxaliplatin
(Eloxatin)

15. Chemotherapy cont’d
• Newer agents used in conjuction with
chemotherapy are the antiangiogenic
(bevacizumab, {Avastin} and the anti-EGFR
immunoglobulin cetuximab (Erbituxl) in the
treatment of oesophageal cancer

16. Photodynamic therapy
• This is a relatively new therapy for treatment
of oesophageal cancer in clients who are not
candidates for surgery
• The client receives an injection of a light
sensitive drug (Photofrin), which is followed 2
days later with a special fiberoptic probe with
a light-bearing tip placed in the oesophagus
• The light activates the Photofrin and kills only
cancer cells

17. Photodynamic therapy cont’d
• This is an outpatient procedure and uses
conscious sedation, takes about 13 minutes to
perform and enables about 1 inch of tumour
to be removed
• Clients return home the same day and resume
their usual activities the same day

18. Maintain nutrition
• This is a major goal for the client
• Not only does the cancer cause the client to
be at risk for malnutrition, but also the
treatments (both radiation therapy and
chemotherapy) carry a risk of mucositis,
nausea, vomiting and dehydration
• Side effects of must be anticipated and
management swift

19. Maintain nutrition
cont’d
• Early in the disease the client may be able to
tolerate small, frequent feedings of soft or
semisoft goods
• As the disease progresses, a feeding tube may be
needed
• If necessary, feeding gastrostomy or jejunostomy
may be created
• Proper positioning after meals is necessary for
those experiencing frequent regurgaitation
• Keep the head of the bed always elevated at 30
defrees