Oesophageal tumors


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Oesophageal tumors

  1. 1. R.Vignesh
  2. 2. BENIGN NEOPLASMS  Leiomyoma (MC ,accounts for 2/3 rd of all benign neoplasms)  Mucosal Polyps  Lipomas  Neurofibroma  Fibromas  Lymphangioma  Haemangiomas
  3. 3. LEIOMYOMA Endoscopic view Barium swallow It is a smooth muscle tumour. Ovoid filling defect Submocosal swelling
  4. 4. SURGICAL REMOVAL Thoracotomy VATS
  5. 5. Mucosal Polyps Lipoma
  6. 6. RISK FACTORS  Heavy Smoking  Alcohol Consumption  Dietary Habits (intake of food contaminated with fungus)  Nutrional Deficiency,Coeliac diseae  HPV infection  About 5% cancer arises from pre-existing pathological lesions 1. Oesophagitis (Barrett’s oesophagus in case of adenocarcinoma) 2. Achalasia 3. Hiatus hernia 4. Plummer-Vinson Syndrome
  7. 7. BARRET’S OESOPHAGUS Squamous Epithelium Columnar Epithelium
  8. 8. 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.
  10. 10. 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
  11. 11. TYPES
  12. 12. ADENOCARCINOMA 1. More common in males 2. It occurs in 4th to 5th decade of life 3. It has nodular and elevated appearance
  13. 13. 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.
  14. 14. 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
  15. 15. DIFFERENTIAL DIAGNOSIS  Foriegn Body  Benign Strictures of oesophagus  Globus Pharyngeus  Cricopharyngeal spasms  Achalasia (Bird beak/ Rat tail appearance in Barium swallow)
  16. 16. CLINICAL EVALUATION  Barium swallow shows narrow and irregular oesophageal lumen, without proximal dilatation of the oesophagus
  17. 17.  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.
  18. 18.  CT scan is useful to assess the extent of disease and nodal metastases Coronal view
  19. 19. 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
  20. 20.  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
  21. 21. (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.
  22. 22. 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%.