8. Endoscopy of Peptic Stenosis due to a Reflux Esophagitis
This 57 year-old man with long-standing reflux disease.
Peptic strictures are sequelae of gastroesophageal reflux–induced esophagitis, and they usually originate from the
squamocolumnar junction and average 1-4 cm in length
9. DIVERTÍCULOS
ESOFÁGICOS
• Se relacionan con 0.4% de los
px con Ca esofágico.
MEMBRANAS
ESOFÁGICAS
• Se relacionan con el
Sindrome de Plummer Vinson.
• Más frecuente en mujeres.
• 10% de las afectadas sufre
éste cáncer.
12. • Metaplasia del epitelio esofágico por islotes de epitelio
cilíndrico en el segmento inferior del esófago.
• Hay un riesgo mayor de 15% de padecer adenocarcinoma.
ESÓFAGO DE BARRETT
Staining of the mucosa with Lugol's solution during
endoscopy has been suggested to identify early cancer
and dysplasia that may improve prognosis.
It has been shown that 40-60% of patients with typical
reflux symptoms have no esophageal mucosal injury.
Lugol chromoendoscopy may be useful for the diagnosis of
so-called endoscopy-negative GERD.
13. • Antecedente de ingestión de cáusticos lejía.
• Exposición a radiación.
• Ocupaciones como: cantineros, camareros y
obreros de la construcción.
14. TUMOR SEGUNDO
PRIMARIO
VIRUS
ENFERMEDAD
CELIACA DE LARGA
EVOLUCIÓN
•Px con antecedente de Ca
de vías respiratorias y
digestivas altas 4% sufrir
segundos tumores
primarios.
•Px con Ca de cabeza y
cuello 35%
VPH
Riesgo mayor de Ca.
causas: toxicidad del
gluten sobre el epitelio y
alteraciones nutricionales.
16. CARCINOMA EPIDERMOIDE
• 90% de los casos
• Localiza esófago torácico medio 50-65% y en
el tercio inferior en 25-35%.
• Se relaciona con Acalasia, Snd de Plummer
Vinson y divertículos esofágicos.
17. CA CELULAS ESCAMOSAS.
• El esófago está normalmente cubierto con
células escamosas. Al cáncer que se origina en
estas células se le llama carcinoma de células
escamosas, el cual puede ocurrir en cualquier
lugar a lo largo del esófago.
18. Adenocarcinoma.
• Se originan de células glandulares se llaman
adenocarcinomas. Este tipo de célula no es
normalmente parte del revestimiento interno
del esófago.
• Antes de que se pueda desarrollar un
adenocarcinoma, las células glandulares
tienen que reemplazar un área de las células
escamosas, como en el caso del esófago de
Barrett.
19. CARCINOMA EPIDERMOIDE
• Macroscópicamente 3 variantes: fungosos, ulcerados y con
infiltración difusa.
• Tumor constituido por nidos de cels cohesivas, poligonales,
ovales o fusiformes que presentan perlas de queratina en su
citoplasma y frecuentes fenómenos de disqueratosis.
• Variedades histológicas más frecuentes: carcinoma in situ,
carcinoma escamoso con patrón sarcomatoide y
carcinoma verrugoso.
20. ADENOCARCINOMA DE
ESÓFAGO
• Representa de 2-5% de la totalidad de los casos.
• Más frecuente en el tercio inferior 60%
• 60-80% de los px se origina a partir del esófago de
Barrett.
• Otros tipos histológicos raros: Ca adenoescamoso,
leiomiosarcoma, Ca de cels pequeñas y Sarcoma de
Kaposi.
21. Endoscopy of Esophageal Squamous Cell Carcinoma.
Ulcerating Squamous cell carcinoma of the lower end of the esophagus.
This 72 year-old female, presented with progressive
dysphagia. In order to determinate the etiology an upper
endoscopy was carried out.
22. Endoscopic appearance of Esophageal Squamous Cell
Carcinoma.
Squamous cell carcinoma of the esophagus is largely associated with a poor prognosis, and the development and metastasis of this tumour are complicated.
Direct invasion of adjacent organs such as the aorta, respiratory tract and lungs, and distant metastasis to other organs such as the liver, lungs and bone are
commonly found in advanced esophageal cancer cases.
Intramural metastasis (IMM) in the esophagus has been found in about 10% of esophageal cancer cases. However, IMM to the stomach (IMMS), excluding direct
invasion and spread to the stomach, is relatively rare.
23. Endoscopic Picture of Esophageal Carcinoma.
The gastric fundus shows a large fungating and ulcerating
lesion, retroflexed image.
A history of smoking and/or alcoholism is often present in patients with esophageal squamous carcinoma, while a history of Barrett's esophagus precedes development
of esophageal adenocarcinoma in many cases.
Pathophysiology
Esophageal carcinoma arises in the mucosa. Subsequently, it tends to invade the submucosa and the muscular layer and, eventually, contiguous structures such as the
tracheobronchial tree, the aorta, or the recurrent laryngeal nerve.
The tumor also tends to metastasize to the periesophageal lymph nodes and, eventually, to the liver, lungs, or both.
24. Epidemiology
At least 5X more common is men with the male/female ratio varying markedly worldwide, probably representin the variable
exposure to environmental factors At least 4X more common in blacks in the U.S., with the incidence in blacks rising while the
incidence in whites is stable or declining A disease of older people with a mean age of onset of 60 yrs.
which probably reflects the slow evolution of the dysplasia carcinoma sequence.
25. }
Etiology.
Examination of geographic areas of high incidence have identified a number of environmental factors strongly linked to the development ofesophageal
dysplasia and squamous carcinoma.
In the United States and Europe alcohol and smoking In China nitrosamine containing foods, fungal contamination of foods and vitamin and essential
metal deficiency.
The only known genetic predisposition occurs in hereditary tylosis, an autosomal dominant symmetrical keratosis of the palms and soles.
