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.
1. More common in males
2. It occurs in 4th to 5th
decade of life
3. It has nodular and
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
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
Blood borne. Metastases may develop in the
liver, lungs, bone and brain.
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
Benign Strictures of oesophagus
Achalasia (Bird beak/ Rat tail appearance in Barium
Barium swallow shows narrow and irregular
oesophageal lumen, without proximal dilatation of
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.
CT scan is useful to assess the extent of disease
and nodal metastases
Surgery of upper two-thirds of oesophagus is difficult
due to great vessels and involvement of mediastinal
nodes. Radiotherapy is the treatment of choice
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
(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.
In India ,oesophageal cancer constitutes 3.6% of all
body cancers in the rich and 9.13% of those in the
Five-year survival is not more than 5-10%.