Zboon Out lines Anatomy and histology of esophagus Incidence and prevalence of esophageal cancer Types of esophageal cancer Clinical picture Approach Carcinoma of the esophagus ID: 930410
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Slide1
Esophageal cancer
Israa
Zboon
Slide2Out lines Anatomy and histology of esophagus Incidence and prevalence of esophageal cancer Types of esophageal cancer Clinical pictureApproach
Slide3Slide4Slide5Slide6Carcinoma of the esophagus Cancer of the esophagus is the sixth most common cancer in the world. -In general, it is a disease of mid to late adulthood, with a poor survival rate Only 5–10% of those diagnosed will survive for 5 years.
Slide7* Epithelial malignancy - Squamous cell carcinoma-
Adenocarcinoma
* non-epithelial
malignancy
malignant
melanoma
.
Leiomyosarcomas Secondary malignancy-bronchogenic carcinoma
Slide8Slide9Clinical features mechanical symptoms : dysphagia, regurgitation, vomiting, odynophagia and weight loss. Clinical findings suggestive of advanced malignancy include : recurrent laryngeal nerve palsy, Horner’s syndrome, chronic spinal pain and diaphragmatic
paralysis.
Cutaneous
tumour
metastases or enlarged
supraclavicular
lymph
nodes may be seen on clinical examination
and indicate disseminated disease.
Slide10- Most patients are asymptomatic till the tumor is advanced. * Dysphagia. - The earliest sign. - Dysphagia does not usually develop until >60% of esophageal lumen is obstructed. - Constant, rapidly progressive. - For solids then liquids. - Associated with reflux
Slide11Investigatons Barium study : change in contourEndoscopy: is the first-line investigation for most patientsCytology and/or histology specimens taken via the endoscope are crucial for accurate diagnosis
Slide12Slide13BLOOD TESTSThese are of limited valueTRANSCUTANEOUS ULTRASONOGRAPHYIt is difficult to visualise mediastinal structures with transcutaneous ultrasonography.Bronchoscopy may reveal either impingement or invasion
of the main airways
in over
30% of new patients with cancers in the upper third
of the
oesophagus
.
Slide14Staging classificationThe International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJCC) have staged esophageal cancer using the TNM
Slide15Slide16Staging (TNM): 1- Endoscopic ultrasound for T and N staging: After haematogenous spread, the two principal prognostic factors for oesophageal cancer are the depth of tumour penetration through the oesophageal wall and regional lymph node spread.
2- CT, then PET scan for
N
staging:
3- CT scan for lung and liver for
distant
metastasis
.
Slide17Slide18Slide19Slide20Slide21Slide22Palliative therapy: ➢ Stenting ➢ Laser therapy. ➢ Phototherapy
Slide23Treatment ➢ Stage 1 and 2→ surgery. ➢ Stage 3→ neoadjuvant chemotherapy/radiotherapy to shrunk the tumor→then surgery. ➢ Stage4/or patients is unfit → chemotherapy/palliative surgery.
Slide24The Siewert-Stein classification of esophageal adenocarcinoma : classes these tumors according to their relationship to anatomical landmarks➢ Stwert 1→ if the tumor above LES → we remove esophagus only ➢ Stwert 2→ invades LES→we remove the esophagus + parts of the
stomach with -
ve
margins.
➢
Stwert
3→ below LES → we remove the stomach with -
ve
margins.
➢ It’s indicated to remove regional lymph nodes as well.
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