1. ESOPHAGEAL CANCER Group 7 members Hardy Ward, Scarla Colon,Nehe Bah
Dharam Bhagwandas,Jennifer Moreta,Adam Hernandez
Larissa Park ,Wendy Rodriguez

2. What is Esophageal Cancer
What is Esophageal Cancer? -Cancer that forms in tissues lining the esophagus.
Two types of esophageal cancer are:
1. Squamous cell carcinoma
-cancer that begins in flat cells lining the esophagus (squamous cells)
* often found in the upper and middle part of the esophagus
2. Adenocarcinoma
-cancer that begins in cells that make and release mucus and other fluids called glandular cells *Adenocarcinomas usually form in the lower part of the esophagus, near the stomach.

3. CAUSES -Tobacco use. -Heavy alcohol use. -Barrett esophagus -A
condition in which the cells lining the lower part of the esophagus have changed or been replaced with abnormal
cells that could lead to cancer of the esophagus.
-Gastric reflux (the backing up of stomach contents into the lower section ofthe esophagus) may irritate the esophagus and, over time, cause Barrett esophagus.
-Older age.
-Being male.

4. DIAGNOSIS -Physical exam and history -Chest x-ray -Barium swallow
-Esophagoscopy-which is a procedure where an esophagoscope is inserted through the mouth or nose and down the throat into the esophagus
-Biopsy- which is the removal of cells or tissues so they can be viewed under a microscope

5. Patient History Female 75 years old
Had breast cancer that metastasized into her esophagus causing for the removal and replacement of the esophagus.
Ivor- Lewis Esophagectomy is the removal of the esophagus and part of the stomach.
Had a gastric pull through where parts of her stomach and small intestine were used to make connection to allow swallowing
A subsequent esophagram was ordered on (7/2/2013) to compare with a previous one from 6/19/2013

6. The Esophagus -which is a hollow organ that carries food and liquids from the throat to the stomach.
-The walls of the esophagus contain two sphincter; the Upper Esophageal Sphincter and the Lower Esophageal Sphincter.
The Upper Esophageal Sphincter (UES) is a muscle that controls
1. Breathing
2.Belching
3.Vomiting
4. Keeping food and liquid from going down the windpipe
ANATOMY

7. ANATOMY CONTINUED.. The Lower Esophageal Sphincter (LES) prevents
1. acid and food contents from moving back up to the esophagus
The wall of the esophagus has several layers that are important for understanding where cancers in the esophagus tend to start and how they grow. The layers are
1.Mucosa
2.Submucosa
3.Muscularis Propria
4.Adventitia

8. ANATOMY CONTINUED
-The mucosa layer contains a part called the Epithelium.
-The Epithelium forms the innermost lining of the esophagus and is normally made up of flat, thin cells called Squamous cells.
-Most cancers of the esophagus start in the squamous cells.

9. NORMAL
VS.
CANCEROUS

10. Exam Procedure
An esophagram was performed on this patient, under fluoroscopy.
No food 12 hours before study
Patient was draped and brought to a prepared room
Patient was placed in an AP upright position for floro
A single contrast study was performed by swallowing barium sulfate suspension
Floro was performed on a lateral to visualize the side and then finished with floro in the RAO position
NOTE:
Equipment used was a GE legacy machine
As for technical factors, floro time was 2 min and 29 sec yielding a dose of cGy *cm square

12. Radiographic Findings
Preliminary radiograph
Trace bilateral pleural effusion
Mild basilar atelectasis
A left PICC line terminating in the SVC
Multilevel discogenic degenerative disease of the thoracic and upper lumbar spine
Swallowing : normal
Mucosal surface: normal within thorax
Structural abnormality:
Status post esophagectomy
No stricture,diverticula, or any other abnormality
Emptying: mild delayed emptying from the stomach into the small bowel
Note: no significant change

13. BEFORE
AFTER

14. Surgical clips on mediastinum in order to raise part of stomach and small intestine for the replacement of the esophagus

15. TREATMENTS
-The options are Surgery,Radiation Therapy,Chemotherapy, or a combination of these.
These therapies depends on
1. Location of cancer
2.Whether the cancer has spread to lymph nodes
3.Patients overall health
-The Chemotherapy and Radiation, may be used to shrink the tumor and make surgeries easier to perform.
-If the patient is too ill to have major surgery or the cancer has already spread to another site, these procedures can be used to reduce symptoms. This is called Palliative Therapy.

16. SUMMARY
Esophageal cancer is a medical condition that can be treated and prevent if found at an early stage. Postoperative people can still have many complications like anastomotic leak, mediastinitis (infection of the mediastinum) atelectasis, pneumonia, adult respiratory distress syndrome, myocardial infarction, pericardial tamponade (blockage), hernia, obstruction, reflux esophagitis and ulceration.The recovery may be a long period of time, although the commitment to therapies and following doctor’s advices could be the key to return to a healthy lifestyle.

17. REFERENCES
1.Das A. Tumors of the esophagus. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010: chap 46.
2.National Cancer Institute: PDQ Esophageal cancer treatment. Bethesda, MD: National Cancer Institute. Date last modified 2/1/2013. Available at: Accessed February 4, 2013.
3.National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Esophageal and esophagogastric junction cancers. Version Available at Accessed February 4, 2013.
4.Sugarbaker DJ, Jaklitsch MT, Liptay MJ: Thoracoscopic staging and surgical therapy for esophageal cancer. Chest 107 (6 Suppl): 218S-223S, 1995.
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