Carcinoma

Carcinoma of oesophagus
• 6th m/c cancer in the world
• Mid-late adulthood
• Poor survival rate
• Only 5-10% diagnosed will survive for 5yrs
 Carcinoma of oesophagus
• SCC: upper 2/3rd ; tobacco & alcohol
• AC: lower 1/3rd ; obesity---GORD---BE---
metaplasia----AC
• Increasing incidence of AC
• LN inv: bad prognostic factor
• m/c presenting feature: dysphagia (late feature)
• Accurate pretreatment staging for pts fit to
undergo curative t/t
 Pathology & Aetiology
• SCC & AC: m/c types
• SCC: m/c worldwide; Nepal
• AC: m/c in West; increasing incidence
• Geography: endemic SCC in Transkei region (South
Africa) & Asian cancer belt (middle of Asia; from
Caspian sea shore of Northern Iran to China)
• m/c cause of death: Linxian in Henan province
(China) >100 cases per 1lakh popn per yr
• Genetic susceptibility, env factors, nutritional
deficiency of beta-carotene, selenium, vitamin E
(central Asia)
• m/c cause of SCC: smoking, alcohol
• Probable Cause of SCC in endemic areas: genetics,
nutritional deficiency (beta-carotene, selenium,
vit E); env factors
• Incidence of SCC: < 5 : 1lakh (white people, USA);
26.5 : 1 lakh (France); static/fallen in Western
countries; dramatic increase in AC since mid-1970
at rate of 5-10% per annum
• AC: 60-75% of oesophageal cancers in some
countries d/t obesity----GERD----BE---Metaplasia--
-AC; increased incidence of carcinoma of cardia of
stomach & AC sharing common etiology
• High risk group: obese white men in their 60s
• 60% UGI cancers in west involve cardia &
distal esophagus with falling incidence of
cancer in rest of stomach
• Early dissemination: AC, SCC
• Classical late triad (advanced well established
d/s prior to diagnosis): dysphagia,
regurgitation, wt loss
 3 ways of spread
Direct invasion through Lymphatics Blood stream
oesophageal wall
a) Laterally thru a) Longitudinal spread: submucosal a) Diff organs:
component layers of lymphatic channels of esophagus liver, lungs,
esophagus brain, bones
b) Longitudinally within b) Continuous pattern of lymphatic
esophageal wall drainage (semental in other parts of
GIT)
c) Esophageal length
involved>>>>macroscopic length at
epithelial surface
d) LN spread: common
e) Direction of regional lymphatic
spread: caudal, widespread, even
cranial
Other spread: f) Primary esophageal lesion----sup.
transperitoneal (tumours Mediatinal RLN---coeliac axis----LC of
arising from intra- stomach
abdominal portion)
 C/Fs
• Mechanical symptoms: principally dysphagia
• Regurgitation;vomiting
• Wt loss (significant : >10% in 6months)
• Odynophagia
• Advanced malignacy: RLN palsy (hoarseness:
advanced incurable d/s); chronic spinal pain;
Horner’s syndrome; diaphragmatic paralysis
(difficulty in breathing); wt loss >20% & LOA (unfit
for sx)
• Disseminated d/s on examn: enlarged SC LNs;
cutaneous tumour mets (palpable neck
lymphadenopathy: advanced d/s sign)