Esophageal Carcinoma

  • 1. Esophageal squamous cell carcinoma
  • 2. Esophageal adenocarcinomas
  • 3. Other malignant epithelial tumors
  •             • Squamous cell carcinoma variants
  •             • Small cell carcinoma
  •             • Malignant melanoma
  • 4. Malignant non-epithelial tumors
  •             • Lymphoma
  •             • Sarcoma
  •             • GIST
  • 5. Benign epithelial tumors
  •             • Granular cell tumor
  •             • Fibrovscular polyp
  •             • Hemartoma
  •             • Hemangioma
  •             •Lipoma

 

  •            Esophageal squamous cell carcinoma
    • – Most common esophageal carcinoma worldwide

    Risk factors for esophageal squamous cell carcinoma

    •      – Smoking (>15 years)
    •      – Alcohol abuse (>200g/week)
    •      – Betel quid
    •      – Low socioeconomic status
    •      – Vitamin A,C,E deficiency
    •      – Folic acid, zinc, selenium deficiency
    •      – Chronic thermal injury( long standing very hot drinks)
    •      – Esophageal web
    •     – HPV infection( 16,18 serotype)
    •     – Plummer-vinson syndrome
    •     – Tylosis

     

    Protective factors for Esophageal Squamous Carcinoma

    • – Obesity
    • – Aspirin / NSAID
    • – Increased intake of fruits and vegetables
  • CLINICAL FEATURES OF ESOHAGEAL CARCINOMA
  • – Asymptomatic in early stage
  • – Weight loss
  • – Progressive dysphagia
  • – Dysphagia is initially with solids but progress to liquids in later stages
  • – Solid food dysphagia occur when the esophageal luminal diameter is 13 mm or less
  • – Odynophagia is a less common feature and indicates ulcerated lesion
  • ♦ Symptoms (Dysphagia) doesn’t appear until the esophageal lumen is >50-60% obstructed by tumor mass
  • Other less common clinical presentation
  • – Iron deficiency anemia
  • – Cervical lymphadenopathy
  • – Chest pain radiating to back due to peri-esophageal structure invasion
  • – Tracheo-esophageal fistula with recurrent pneumonia or pleural effusion
  • – Hoarseness due to laryngeal nerve injury for tumor pressure or associated lymphadenopathy
  • – Metastasis to lung,liver,brain,bone
  • Site of involvement of Esophageal Carcinoma
  • – Upper 1/3rd – 15%
  • – Middle 1/3rd – 50%
  • – Lower 1/3rd – 35%
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  •                                                      Staging of Esophageal Carcinoma:

 

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  • Treatment of Esophageal Carcinoma:
  • 1.Endoscopic Treatment of Esophageal Carcinoma
  •  
  1. Curative intent
    • Only for mucosal tumor (T1a)
    • Mucosal tumors have less chance of LN metastasis
    • Submucosal tumors have increased chance of LN metastasis
  2. Palliative treatment
  •                                                                    Endoscopic  Curative Treatment

 

 

  •                                                    Endoscopic Palliative  Treatment

 

  • 2. Surgical Treatment of Esophageal Carcinoma:
  • Prognosis of Esophageal Carcinoma:
  •      – Overall 5 year survival rate: 10-15%
  •      – 5 year survival rate for
  •      – T1: No nodal involvement – 40%
  •      – T2: No nodal involvement – 40%
  •     – T3, T4 : 25%
  • – N0: 70%
  • – N1: 40%        Independant of T classification

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