9. CARCINOMA OF OESOPHAGUS
There are various subtypes
Squamous cell carcinoma (approx 90–95% of all
esophageal cancer worldwide) Squamous cell
cancer arises from the squanous epithelium that
lines the upper part of the esophagus.
Adenocarcinoma (approx. 5-10% of all esophageal
cancer). Adenocarcinoma arises from glandular
cells that are present at the junction of the
esophagus and stomach.
11. SQUAMOUS CELL CARCINOMA
1. Arises from the
squamous epithelial
lining of the
oesophagus
2. Most common in men
than women
3. Disease occurs more
commonly in the 6th to
7th decade of life
13. ADENOCARCINOMA
1. More common in males
2. It occurs in 4th to 5th
decade of life
3. It has nodular and
elevated appearance
14. METASTASIS
Direct. The lesion may fill the lumen and infiltrate
the wall of oesophagus. It may also spread to the
adjoining structures such as the trachea, left
bronchus, aorta or pericardium. Involvement of
the recurrent laryngeal nerves causes aspiration
problems.
Lymphatic. Depending on the site involved,
cervical, mediastinal or coeliac nodes may be
involved. Cervical and thoracic lesions also spread
to supraclavicular nodes. "Skip lesions" may
also occur due to spread through the submucosal
lymphatics.
Blood borne. Metastases may develop in the
liver, lungs, bone and brain.
15. SIGNS & SYMPTOMS
Early symptoms include substernal discomfort
and preference for soft or liquid food.
Progressive dysphagia and emaciation.
Dysphagia first to solids and then to liquids. Patient
loses weight and becomes emaciated.
Pain. Usually signifies extension of tumour beyond
the walls of oesophagus.
Aspiration problem. Spread of cancer may cause
laryngeal paralysis or fistulae formation leading to
cough, hoarseness of voice, aspiration pneumonia
and mediastinitis
16. DIFFERENTIAL DIAGNOSIS
Foriegn Body
Benign Strictures of oesophagus
Globus Pharyngeus
Cricopharyngeal spasms
Achalasia (Bird beak/ Rat tail appearance in Barium
swallow)
17. CLINICAL EVALUATION
Barium swallow shows narrow and irregular
oesophageal lumen, without proximal dilatation of
the oesophagus
18. Oesophagoscopy. Useful to see the site of
involvement, extent of the lesion, and to take
biopsy. Flexible fibre optic oesophagoscopy
obviates the need for general anaesthesia and
gives a magnified view.
19. CT scan is useful to assess the extent of disease
and nodal metastases
Coronal view
20. TREATMENT
Surgery of upper two-thirds of oesophagus is difficult
due to great vessels and involvement of mediastinal
nodes. Radiotherapy is the treatment of choice
21. Surgery is the preferred method of treatment for
cancer of lower one third. The affected segment, with
a wide margin of oesophagus proximally, and the
fundus of stomach distally, can be excised with
primary reconstruction of the food channel
22.
23. (iii) Oesophageal intubation with Celestin or
Mousseau-Barbin or a Atkinson tube to provide an
alternative food channel .
(iv) Laser surgery: Oesophageal growth is burnt with
Nd: YAG laser to provide a food channel.
Chemotherapy is used only as a palliative measure in
the locally advanced or disseminated disease.
24. PROGNOSIS
In India ,oesophageal cancer constitutes 3.6% of all
body cancers in the rich and 9.13% of those in the
poor
Five-year survival is not more than 5-10%.
