1. CARCINOMA OF ESOPHAGUS

6. 10th most common in the world
6th most common cause of death in the world
IN PAKISTAN
10th most commmon in karachi (akuh study )
3rd most common in Quetta ( JPMA)

7. types Squamous cell carcinoma (upper2/3) Adenocarcinoma (lower 1/3)
lymphomas
Melanomas

8. Squamous cell is endemic in South Africa, Iran ,China .
China ….the highest in the world
Is it genetic susceptibilty ?
Nutritional deficiencies ?
( studies have shown that supplements like VitE , Bcarotene Selenium reduced the incidence of Ca in china )

9. Other Causes Tobacco Niswar Paan
Alcohol ( with smoking has a synergistic effect )
Fast food

10. Risk factor GERD BARRETS ESOPHAGUS
( american society of gastroeneterlogists recommends endoscopy every6-12 months in low grade dysplasia
Every 3months in high grade dysplasia)

11. Unique anatomy of esophagus
Makes the spread early and prognosis worse
Indistinct SEROSA
Submucosal lymphatics
thus lymph node involvement is as high 25% in submucosal invasion
T2 lesion has 50 % chance of lymphatic invasion

12. SPREAD DIRECT ( longitudinal /transverse)
LYMPHATICS..(superior medistinum,coelic axis, lesser curvature)
BLOOD BORNE (liver , lungs, brain , bones)

13. CLINICAL FEATURES DYSPHAGIA WEIGHT LOSS Anorexia Hoarseness
Horners syndrome
Back pain
Supraclavicular lymphadenopathy

14. Empyema
Cough
stridor

15. DIAGNOSIS

16. Diagnosis
barium swallow

17. Endoscopy

19. Endoscopic biopsy
To confirm diagnosis

20. Staging investigations
CT CHEST/ ABDOMEN
Length of tumor
Depth of invasion
Lymph node involvement
Liver lungs metastasis

22. MRI No exposure to ionizing radiations
However does not give any additional benefit over CT

23. PET SCAN Assessment of tumor size Lymph node status distant metastasis
Specificity and senstivity slightly exceeds CT

25. EUS
VERY INFORMATIVE
ULTRASOUND GUIDED BIOPSY OF LYMPH NODES CAN BE TAKEN

26. TNM Staging of CA ESPHAGUS
Tis : high grade dysplasia
T1 : tumor invading lamina propria or submucosa
T2:tumor invading muscularis propria
T3:tumor beyond muscuaris propria
T4:tumor invading adjacent structures

27. NO:No lymph nodes
N1:lymph node 1-2
N2:lymph node 3-6
N3:lymph node7+
MO:none
M1:distant metastasis

28. CLINICAL STAGES STAGE 1 T1 NO MO T2 NO MO STAGE 2 T3 NO MO STAGE 3
T1/2 N2 MO
T4 N1 MO
AnyT any N but M1

29. TREATMENT MODALITIES
SURGERY
RADIOTHERAPY
CHEMOTHERAPY

30. American society of cancer (2017) recommends the following
STAGE 0
PDT, RFA, EMR
STAGE 1
Surgery alone
upper 1/3 chemo radiation
STAGE 2/STAGE 3
Neo adjuvant chemo radiation
surgery
STAGE 4
Stent pacement
Laser ablation
Brachytherapy
PDT
FEEDING JEJUNOSTOMY

33. COMPLICATIONS OF SURGERY
Anastomotic leak
Chylo thorax
Atelectasis
Recurrent laryngeal nerve injury
Damage to adjacent vital structures