esophageal cancer or esophageal carcinoma

Esophageal cancer

What is esophageal cancer ?

It is a malignant tumour arises from the esophagus with two major histological types that are squamous cell carcinoma or adenocarcinoma,

What cause esophageal cancer ?


Squamous cell carcinoma is caused by smoking ( tobacco), alcohol, Paterson -kelly syndrome or known also as Plummer Vinson syndrome,tylosis, achalasia, scleroderma, coeliac disease, certain nutritional deficiency, ( vitamin A,C and trace elements) and dietary toxins ( nitrosamine) also implicated.

Adenocarcinoma is caused by gastroesophageal reflux disease and Barret esophagus.

What is the statistic of esophageal cancer ?

It is the eight most common malignancy with annual incidence in UK IS 7000 - 8000 PER YEAR. It is 3 times more common in males.Squamous cell carcinoma is common in developing countries and shows geographic variations ( common in northern iran, china and parts of south africa. Adenocarcinoma is common in /more prevalent in the west ( 65% in the UK ) and increasing at a rates of 5- 10 % per year.

How does esophageal cancer present ?


oftenly it is asymptomatic, causing symptoms when locally advanced such as progressive dysphagia, which is initially worse for solid, regurgitation , cough or choking after food , voice hoarseness , pain ( odynophagia), weight loss and fatigue ( iron deficency anemia) .

No physical signs may be evident, with cancer that has spreads, there will be evidence of supraclavicular lymphadenopathy , hepatomegaly , hoarseness due to reccurent laryngeal nerve involvement.

What is the pathology behind esophageal cancer ?

Macroscopically it may present as polypoid, fungating or infiltrative tumours

Microscopically it may present in case of squamous cell carcinoma as oval sheets of cells with keratinisation and intracellular prickles ( if differentiated ) . Adenocarcinoma usually develops at the lower part of esophagus or gastro esophageal junction , may have an intestinal ( glandlike tubular growth pattern ) or diffuse ( sheets and aggregates of tumour cells, with mucin and compressed nucleus giving the cell a signet ring apperances.) growth pattern.Spreads is typically initally direct and longitudinal via submucosal lymphatics with eraly invasion of mediastinal structures due to lack of esophageal serosa. Rare esophageal tumours include lymphoma, melanoma and leiomyosarcoma.

How to diagnose esophageal carcinoma ?

Endoscopy is useful for brushing and cytology while endoscopic ultrasound for staging.
Barium swallow and chest x ray for imaging and CT scan of the chest and abdomen again for staging the tumour. Other investigation includes bronchoscopy ( if risk of tracheo branchial invasion ) , lung function test and arterial blood gasses, bone scans for surgery when its planned and laparoscopy if tumour involved the gastroesophageal junction.

How to manage esophageal carcinoma ?

The best management involved specialist centre with multidisciplinary expertise.
Surgical with 30% are suitable for surgical resection.Neoadjuvant chemotherapy ( cisplastin, 5 fluorouracil ) may be beneficial in downstaging tumour prior to surgery. Operative approach depends on tumour location and the extent of proposed lymphadenectomy. Examples are two to three stages subtotal esophagectomy or transhiatal total gastrectomy with Roux - en- Y jejunal reconstruction ( the latter for only gastroesophageal junction tumour).Approaches by which these are carried out include the sweet left thoraco abdominal approach (low tumour), the Ivor -Lewis right thoracotomy and laparotomy (mid lower third tumours) and transhiatal approaches i.e laparatomy and cervical approach (upper third tumours). Reconstruction is by mobilising and pulling up the stomach on a vascular pedicle of the right gastroepiploic and right gastric arteries, isoperistaltic interposition of a section of a right colon , or Roux-en-Y jejunal reconstruction. Recent studies show an improvement of survival with more extensive lymphadenectomy .

Palliation involved luminal reconstruction by expandable stents or laser ablation techniques.Chemotherapy is associated with variable response rates ( epirubicin, cisplatin and 5 flurouracil).

Radiotherapy is more useful with squamous cell carcinoma than adenocarcinoma.


What is the complication of esophageal carcinoma?

The complication includes aspiration pneumonia, malnutrition and esophago - branchial fistula.
Patient may present with post op complication such as pilmonary complication that includes atelectasis and pneumonia ,others include leakage in the anastomosis, chylothorax and recurrent laryngeal nerve damage which is the serious complication and required prompt treatment.

What is the prognosis of esophageal cancer ?

The prognosis is poor with 5 year suurvival rates less than 10% . After attempted curative resection 5 year survival is only 20-25%. Unfortunately at present for most patients the survival rates is only months.

Esophageal cancer statistic

Esophageal cancer surgery

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