ESOPHAGEAL CANCER BY :BILAL HUSSEIN

Objectives Introduction Epidemiology Classification Symptoms Risk factors Diagnosis Stages Treatment Prevention

Introduction Esophageal cancer is abnormal cellular growth in the muscular tube that connect pharynx to the stomach . Esophageal cancer usually begins in the cells that line the inside of the esophagus, and can occur anywhere along this hollow tube. It occurs most frequently in the middle portion of the esophagus , and more men than women are prone to the development of the disease.

Epidemiology Esophageal cancer is the eighth most frequently diagnosed cancer worldwide, and it causes about 400,000 deaths every year. Esophageal Squamous Cell Carcinomas comprise about 60–70% of all cases of esophageal cancer worldwide, while Esophageal Adenocarcinomas account for a further 20–30%. Melanomas, leiomyosarcomas, carcinoids and lymphomas are less common types. The countries with the highest estimated national incidence rates were (in Asia) Mongolia and Turkmenistan and (in Africa) Malawi, Kenya and Uganda. The countries with highest recorded rates were the UK, netherlands, ireland and new zealand . Esophageal cancer is the sixth most common cause of cancer deaths worldwide.

clasification 2-adenocarcinoma. There are 2 main types : 1-squamus cell carcinoma. 2-adenocarcinoma.

Squamous cell carcinoma Squamous cell carcinoma. The squamous cells are flat, thin cells that line the surface of the esophagus. It occurs most often in the upper and middle portions of the esophagus. Squamous cell carcinoma is the most prevalent esophageal cancer worldwide. Adenocarcinoma. It begins in the cells of mucus-secreting glands in the esophagus. It occurs most often in the lower portion of the esophagus. Adenocarcinoma is the most common form of esophageal cancer in the United States, and it affects primarily white men.

Symptoms

dysphagia Weight loss Chest pain, pressure or burning Worsening indigestion or heartburn Coughing or hoarseness Regurgitation or vomiting.

Risk factors

Risk factors GERD Smoking Barrett's esophagus Being obese Drinking alcohol achalasia Having a steady habit of drinking very hot liquids Not eating enough fruits and vegetables Undergoing radiation treatment to the chest or upper abdomen

Diagnosis

Endoscope is a flexible, narrow tube with a tiny video camera and light on the end that is used to look inside the body. Tests that use endoscopes can help diagnose esophageal cancer or determine the extent of its spread.  Endoscopic ultrasound, a probe that gives off sound waves is at the end of an endoscope. This allows the probe to get very close to tumors in the esophagus. This test is very useful in determining the size of an esophageal cancer and how far it has grown into nearby areas.  CT scan uses x-rays to produce detailed cross-sectional images of your body. This test can show if esophageal cancer has spread to nearby organs and lymph nodes or to distant parts of the body. PET scans usually use a form of radioactive sugar (known as fluorodeoxyglucose or FDG) that is injected into the blood. Normal cells use different amounts of the sugar, depending on how fast they are growing. Cancer cells, which grow quickly, are more likely to absorb larger amounts of the radioactive sugar than normal cells.

Stages

TNM classification TIS : high grade dysplasia . T1 : tumor invading lamina propria or submucosa . T2 : tumor invading muscularis propria . T3 : tumor invading beyond muscularis propria. T4a : tumor invading adjacent structures (pleura ,pericardium ,diaphragm) T4b : tumor invading adjacent structures (trachea, bone ,aorta) N0 :no lymph nodes metastasis N1 : lymph nodes metastasis in 1-2 nodes N2 : lymph nodes metastasis 3-6 nodes N3 : lymph nodes metastasis in 7 or more lymph nodes M0 :no distant metastasis M1 :all other distant metastasis

Test used in staging esophageal cancer include CT and PET : Stage I :this cancer occur in the superficial layers of cells lining the esophagus . Stage II : this cancer has invaded deeper layers of the esophagus lining and may have spread to nearby lymph nodes Stage III : this cancer has spread to the deepest layers and to near by tissues or lymph nodes . Stage IV : the cancer has spread to other parts of the body (metastasis)

Treatment

Surgery to remove very small tumors Surgery to remove very small tumors.If the cancer is very small, confined to the superficial layers of the esophagus and hasn't spread, the surgeon may recommend removing the cancer and margin of healthy tissue that surrounds it. Surgery to remove a portion of the esophagus (esophagectomy). the surgeon removes the portion of the esophagus that contains the tumor and nearby lymph nodes. The remaining esophagus is reconnected to the stomach. Surgery to remove part of the esophagus and the upper portion of the stomach (esophagogastrectomy). the surgeon removes part of the esophagus, nearby lymph nodes and the upper part of the stomach.

Chemotherapy and radiotherapy

Chemotherapy is drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically used before (neoadjuvant) or after (adjuvant) surgery in people with esophageal cancer. Chemotherapy can also be combined with radiation therapy. Radiation therapy uses high-powered energy beams to kill cancer cells. It can come from a machine outside the body that aims the beams at the cancer cells (external beam radiation). Or radiation can be placed inside the body near the cancer cells (brachytherapy). Radiation therapy is also used to relieve complications of advanced esophageal cancer, such as when a tumor grows large enough to stop food from passing to your stomach.

Prevention Quit smoking Quit Drinking alcohol Eat more fruits and vegetables, Add a variety of colorful fruits and vegetables to your diet. Maintain a healthy weight

References https://www.mayoclinic.org/diseases-conditions/esophageal-cancer/symptoms-causes/syc-20356084 https://www.cancer.org/cancer/esophagus-cancer/detection-diagnosis-staging/how-diagnosed.html Bailey and love’s short practice of surgery ,26th edition , part 11 ,p 1004 .

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