1. Pharynx & esophagus
Mazidi MD

2. Anatomy
Pharynx: nasopharynx
oropharynx
hypopharynx

4. Nasopharyngeal SCC Risk factors: China , FH+ , diet, EBV,male,30-60 y,
Not smoking
Neck mass , bloody PND(not epistaxis), OME, nasal obstruction, cranial nerve palsy(6)
Dx : endoscopy
biopsy
CT,MRI
Rx: radiotherapy +_chemotherapy

5. Oropharynx SCC Etiology: tobacco ,alcohol , betel nut , HPV
Vegetable & fruits are supportive factors
Sore throat , Dysphagia , odynophagia , hemorrhage, neck mass , OME
Dx: imaging,biopsy
Rx : surgery +_ radiotherapy

7. Hypopharynx SCC Pyriform sinus , pos wall , post cricoid Male , black
Presentation : neck mass , no manifestation, GERD ,sore throat ,dyspnea , otalgia
Dx : CT , MRI , PET
Etiology: alcohol , tobacco , poor socioeconomic , diet , genetic , plumer-vinson syn.
Rx : surgery +_ radiotherapy

10. Esophagus :Anatomy
UES : inf constrictor m.+ cricopharyngeous m. LES Esophagus length:18-26 cm, pos mediastinum Layers : mucosa submucosa muscularis propria : circular & longitudinal m.

12. Innervation: smooth m……vagus n.
skeletal m……myenteric or auerbach plexus ( pristaltism)
meissner plexus (sensory)
UES : closed because of neural excitation (in sleep & GA : open)
LES : closed as a result of muscular tonicity
open in swallowing & esophageal or gastric distention

13. Esophageal symptoms
heartburn
Dysphagia
Odynophagia
Regurgitation

15. Esophageal testing Endoscopy : mucosal & structural disorders
Manometer : motility disorders ( gold standard)
PH monitoring : R/O GERD
efficacy of therapy
abnormal test : reflux episodes >4.2%

17. neoplasm RF :alcohol , tobacco , male , caustic
injury , achalasia , plummer-vinson
Hx of H & N SCC , HPV
Pathology;
SCC : mid esophageal
Adenocarcinoma : distal
Ph.E :dysphagia , weight loss

18. Staging
Rx : T1 T2………surgery
T3 T4…….neoadjoant chemo
radiation + surgery