2. Еsophageal cancer
◼ This is one of the most severe
diseases of the esophagus.
Increased incidence in the world
in recent years.
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3. Сlinical anatomy
◼ The esophagus is a tubular organ , the
length of an adult 25 - 30 cm. There are
cervical, thoracic and abdominal part of the
esophagus . Esophagus has physiological
narrowing in three places. The first is the
place of transition of the pharynx into the
esophagus , the second - at the level of IV -
V thoracic vertebrae , which adjoins the left
main bronchus to the esophagus , and the
third - at hiatal .
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4. Сlinical anatomy
◼ Esophageal cancer occurs more
frequently in areas of physiological
restrictions .
◼ Esophageal wall consists of an outer (
connective tissue ) , muscle and
mucosal membranes.
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5. Epidemiology
◼ Esophageal cancer ranks 14th place
in the structure zlokachetsvennyh
tumors is 2-5% of all malignant
tumors.
◼ • Esophageal cancer occurs more
frequently in men aged 50 - 60 years.
◼ • The ratio of men and women in
different age groups is on average
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6. Epidemiology
◼ High frequency of esophageal cancer
is found in Central Asia, Kazakhstan,
Yakutia, Mongolia and China.
Increased frequency of esophageal
cancer in France, Brazil, India, and
the United States among black
people.
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7. ETIOLOGY & RISK FACTORS
◼ smoking
◼ alcohol
◼ Food (hot food, beverages, meslokostistaya
fish, etc.)
◼ A deficiency of vitamins A, C and
ribovlavina.
◼ Chronic diseases of the esophagus: scar
narrowing after chemical burns, achalasia,
hiatal hernia, reflux esophagitis.
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8. Premalignant disease
◼ Chronic esophagitis is considered a
precancerous condition of the
esophagus. It is often accompanied
by epithelial dysplasia of the
esophageal mucosa.
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9. Localization
◼ Esophageal cancer develops most often in
places of natural contractions. Most often
the tumor occurs in the middle third of the
thoracic esophagus (40 - 70%). Tumors in
the lower third of the esophagus - 25 -
40%. Cancer occurs rarely in the upper
third of the chest, neck and abdominal
parts of the esophagus.
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10. Forms of growth
◼ Distinguish three forms of growth in appearance :
◼ • Exophytic - tumor grows in the node into the
lumen of the esophagus, has clear boundaries ,
breaks easily. Stroma is poorly developed in
these tumors , these tumors are soft to the touch
( soft cancer ) .
◼ Endophytic cancer - has a well-developed stroma
, is a dense whitish tissue circularly covers the
esophagus , dramatically narrows the lumen of
the esophagus.
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11. Forms of growth
◼ The most common form of cancer .
It is characterized by early decay and
ulceration and has the form ulcers
with raised edges thickened wall and
infiltration beyond the tumor.
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12. Histology
◼ Or non-cornified squamous cell cancer is
more common, at least - basal cell and
adenocarcinoma.
◼ The first stage of nodal metastasis are
prevertebral and rear mediastinal lymph
nodes. Redistribution perhaps retrograde
metastases in celiac and gastric lymph
nodes. metastases often affects the liver,
lungs, kidneys from the internal organs.
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15. Symptoms
◼ Typical symptoms of esophageal cancer are
caused by the phenomenon of obturation.
◼ • Dysphagia - difficulty in the passage of
food through the esophagus. Dysphagia
caused by narrowing of the body growing
tumor (mechanical dysphagia), but
sometimes it depends on the underlying real
spasm of the esophagus (reflex dysphagia).
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16. Symptoms
◼ Esophageal vomiting - usually due to spasm and
occurs immediately after a meal. Esophageal
vomiting occurs in patients with severe stenosis,
some time after the meal.
◼ • Excessive salivation (hypersalivation). It is a
protective reflex that facilitates overcoming
obstacles food.
◼ • Unpleasant fetid breath, which depends on the
tumor and putrid decay processes above the
constriction.
◼ • Progressive weight loss, weakness, fatigue.
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17. Diagnostics
◼ Poll
◼ X-ray study (fluoroscopy and radiography of the
esophagus)
◼ Endoscopy of the esophagus (esophagoscopy)
◼ Fibro laringo bronchoscopy (to assess the
condition of the larynx reserve unit)
◼ Ultrasonography - study lymph system neck and
supraclavicular lymph collectors, upper and lower
mediastinum, abdominal and retroperitoneal
space.
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18. Diagnostics
◼ Computed tomography of the chest
and abdominal cavities.
◼ Laparoscopy - with signs of transition
esophageal tumors on the stomach.
◼ Biopsy.
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19. Stage I (T1N0M0) Esophageal Cancer
◼ Cancer is in the
mucosa and
submucosa (the two
inside layers of the
esophagus)
◼ Cancer cells are in the
lining of the
esophagus
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20. Stage IIA (T2N0M0 or T3N0M0)
Esophageal Cancer
◼ Cancer is in either of
the two outer layers
of the esophagus
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21. Stage IIB (T1N1M0 or T2N1M0 )
Esophageal Cancer
◼ Cancer is in the
submucosa or
muscular layer of the
esophagus
◼ Cancer has spread to
some lymph nodes
near the tumor
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22. Stage III (T3N1M0 or T4anyNM0)
Esophageal Cancer
◼ Cancer is in the
outside layer of the
esophagus or in the
tissue near the
esophagus
◼ Cancer has spread to
lymph nodes near the
tumor
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23. Stage IVA (anyTanyNM1a) Esophageal
Cancer
◼ Cancer has spread to
the lymph nodes in
the abdomen or neck
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24. Stage IVB (anyTanyNM1b) Esophageal
Cancer
◼ Cancer has spread to
other parts of the
body besides the
lymph nodes
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26. How to design the treatment plan
◼ Staging
whether the cancer has invaded nearby
structures
whether the cancer has spread to lymph nodes
or other organs
◼ where the cancer is located within the
esophagus
◼ The general health of patient
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27. Treatment
◼ The choice of method depends on the
radical treatment of tumor localization.
Use radiation therapy, resection or
extirpation of the esophagus.
◼ • In cancer of the abdominal part and the
lower third of the esophagus - resection of
the esophagus and gastric cardia with
simultaneous imposition of esophageal -
gastric anastomosis.
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28. Treatment
◼ In cancer, the middle third of the
thoracic esophagus-extirpation of the
esophagus. The operation was
performed in two stages. Step 1 -
Remove the thoracic part of the
esophagus. For 3 - 6 months. The
patient is fed through a gastrostomy.
Spend esophagoplasty if during this
period no metastases found in Step 2.
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29. Treatment
◼ Radiation therapy.
◼ Chemotherapy is ineffective in
esophageal cancer. Using temporary
remission drugs: bleomycin, cisplatin,
adriamycin, methotrexate.
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30. Prognosis
◼ Radical surgical treatment leads to a 5-
year recovery 9 - 15% of patients. At one
stage, the 5-year cure rate reached 60%
of patients. 2 times lower survival in
patients with stage 2 disease. Worse long-
term outcomes of patients stage 3
disease. The combination of surgery and
radiation therapy increases the
effectiveness of treatment.
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