Cancer Esophagus causes, pathology, diagnosis and treatment

Cancer esophagus is one of the most lethal of all cancers (Carcinoma of the esophagus) .

Predisposing factors:

It is more common in old males (60-70 years).
Smoking, alcohol, achalasia or reflux and Barrett's esophagus. i.e. columner metaplasia of the lower esophagus  .
Tylosis (hereditary disorder of squamous epithelium) with hyperkerosis of palms and soles.
Corrosive strictures.
Plummer-Vinson syndrome .

Pathology of Carcinoma of the esophagus

- Macroscopically: The lesion is usually ulcerative & it extends around the wall of the esophagus, causing narrowing.

- Microscopically: It is usually squamous cell carcinoma. Also adenocarcinoma may arise in columnar epithelium of Barrett's esophagus, due to longstanding reflux

Spread: Direct, haematogenous or through lymphatics.

How to diagnose Esophageal carcinoma ?

Clinical features :
- Progressive dysphagia, first to solids and eventually to fluids.
Weight loss, due to dysphagia and anorexia.
Mediastinal syndrome.
Late the esophageal obstruction causes difficulty in swallowing and coughing with pulmonary aspiration.
Investigations :

1. Barium swallow: - Irregular filling defect with shouldering sign.
                                 - Rat-tail appearance may occur.
2. Esophagoscopy: with biopsy.
3- CT scan of chest & abdomen for size of the tumor & spread outside the esophagus.

Treatment approaches of Cancer Esophagus 

A. Surgical resection: If the tumor has not infiltrated outside the esophageal wall followed by chemotherapy and radiation, but unfortunately most patients presented late.

B. Other methods of restoring swallowing, in cases of metastatic disease:

1. Radiotherapy is limited for squamous cell carcinoma of the upper and middle third.
2. Chemotherapy (5-fluouracil and cisplatin) can be used with radiotherapy.
3. Palliative maneuvers: stent application or by-pass operation to allow fluids and soft food to be eaten or local destruction of the tumour by laser.
Cancer Esophagus causes, pathology, diagnosis and treatment
Dr.Tamer Mobarak


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