Transcript DR BLESSINGS PRESENTATON

ESOPHAGEAL CA
EZE BLESSING
1466
introduction
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Esophageal cancer
(or oesophageal
cancer) is cancer
arising from the
foodpipe known as
the esophagus that
runs between the
throat and the
stomach. Pnemonia
can be a
BENIGN
Squamous
Papilloma
Esophageal
leiomyoma
Papillary fronds lined by several
layers of hyperplastic squamous
epithelium around a fibrovascular
core
May be associated with HPV
Demarcated intramural nodule, composed of
composed of irregularly oriented bundles of
well-differentiated smooth-muscle cells
Normal Squamous epithelium is seen on top
TYPES
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The two main sub-types of the disease are
esophageal squamous-cell carcinoma (often
abbreviated to ESCC), which is more common
in the developing world, and esophageal
adenocarcinoma (EAC), which is more
common in the developed world.
A general rule of thumb is that a cancer in the
upper two-thirds and middle one 3rd is likely
to be ESCC and one in the lower one-third
EAC.
SQUAMOUS CELL CANCER
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Arises from epithelial cells of the esophagus
RISK FACTORS:The most common causes of the
squamous-cell type are: tobacco, alcohol,
achalasia,very hot drinks, and a poor diet. High levels
of dietary exposure to nitrosamines.oral hygiene
Chewing betel nut (areca) is an important risk factor
in Asia
Genetic factors: p16/INK4 tumor suppressor gene
and EGFR, p53 in 50% of esophageal cancers
Squamous cell carcinoma
– morphology
Mucosal epithelial dysplasia -> carcinoma
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in situ -> invasive cancer
(1) polypoid exophytic masses
(2) necrotizing ulcerations
(3) diffuse infiltrative neoplasms
ESCC STAGING
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Stage 1A:Cancer has grown through the inner layer and invaded the wall of
the esophagus. The grade is 1.
Stage IB
Cancer has invaded the wall of the esophagus and is grade 2 or 3. Or,
cancer is found in the lower part of the esophagus, it has invaded the
muscle layer or outer layer of the esophagus, and the grade is 1.
Stage IIA
Cancer is found in the upper or middle part of the esophagus, it has invaded
the muscle layer or outer layer of the esophagus, and the grade is 1. Or,
cancer is found in the lower part of the esophagus, it has invaded the
muscle layer or outer layer of the esophagus, and the grade is 2 or 3.
Stage IIB
Cancer is found in the upper or middle part of the esophagus, it has invaded
the muscle layer or outer layer of the esophagus, and the grade is 2 or 3. Or,
cancer has not invaded the outer layer, and cancer cells are found in one or
two nearby lymph nodes.
ADENO CA
The most common causes of the adenocarcinoma type are
GERD smoking tobacco, obesity, and acid reflux
 RISK FACTORS: male gender, acid reflux, obesity.
Adenocarcinoma is the more common type of esophageal
cancer. Having Barrett esophagus increases the risk of this
type of cancer. Acid reflux disease (gastroesophageal reflux
disease, or GERD) can develop into Barett esophagus.
Other risk factors include smoking, being male, or
being obese.
PROTECTIVE EFFECT: Female hormone, h pylori,
prolonged period of breastfeeding declines risk
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Barrett esophagus - sequelae
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Ulceration, Bleeding, Stricture
Adenocarcinoma
EAC STAGING
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Stage IA
Cancer has grown through the inner layer and invades the wall of the
esophagus. The grade is 1 or 2.
Stage IB
Cancer has invaded the wall of the esophagus and is grade 3. Or, cancer has
invaded more deeply into the muscle layer of the esophagus, and the grade
is 1 or 2.
Stage IIA
Cancer has invaded the muscle layer of the esophagus, and the grade is 3.
Stage IIB
Cancer has invaded the outer layer of the esophagus. Or, cancer has not
invaded the outer layer, but cancer cells are also found in one or two nearby
GERD cont.
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The long-term erosive effects of acid reflux (an extremely common
condition, also known as gastroesophageal reflux disease or
GERD) have been strongly linked to this type of cancer.
Longstanding GERD can induce a change of cell type in the lower
portion of the esophagus in response to erosion of its squamous
lining.This phenomenon, known as Barrett's esophagus, seems to
appear about 20 years later in women than in men, maybe due to
hormonal factors. Having symptomatic GERD or bile reflux makes
Barrett's esophagus more likely, which in turn raises the risk of
further changes that can ultimately lead to adenocarcinoma. The
risk of developing adenocarcinoma in the presence of Barrett's
esophagus is unclear, and may in the past have been overestimated.
sypmtoms
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Painful or difficult swallowing
Weight loss
A hoarse voice or cough that doesn't go away
enlarged lymph nodes (glands) around the
collarbone, a dry cough, and possibly coughing
up or vomiting blood
Backwards movement of food through the
esophagus and possibly mouth (regurgitation)
Chest pain and heart burns
Vomiting blood
EPIDERMIOLOGY
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Esophageal cancer is the eighth most frequently diagnosed cancer worldwide, and
because of its poor prognosis it is the sixth most common cause of cancer-related
death
ESCC comprises 60–70% of all cases of esophageal cancer worldwide, while EAC
accounts for a further 20–30% (melanomas, leiomyosarcomas, carcinoids and
lymphomas are less common types).
In general, ESCC is more common in the developing world, and EAC is more
common in the developed world
In Western countries, EAC has become the dominant form of the disease, following
an increase in incidence over recent decades (in contrast to the incidence of ESCC,
which has remained largely stable). In 2012, the global incidence rate for EAC was
0.7 per 100,000 with a strong male predominance (1.1 per 100,000 in men vs. 0.3 in
women) Areas with particularly high incidence rates include northern and western
Europe, north America and Oceania. The countries with highest recorded rates were
the UK, Netherlands, Ireland, Iceland and New Zealand
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Doctor uses imaging tests and a biopsy to
diagnose esophageal
cancer
DIAGNOSES
The disease is diagnosed by biopsy done by an
endoscope (a fiberoptic camera)
generally tend to be fairly poor, as diagnosis is
often late. Five-year survival rates are around
13% to 18%
Staging.
CT scan
Esophagogastroduodenoscopy (EGD) and biopsy
PET scan (sometimes useful for determining the
stage of disease, and whether surgery is possible
PREVENTION
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Do not smoke
Limit or do not drink alcoholic beverages
Get checked by your doctor if you have severe
GERD
Get regular checkups if you have Barrett
esophagus
TREATMENT
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Treatment is based on the cancer's stage
and location, together with the person's
general condition and individual
preferences.
Chemotherapy
surgery
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A 58-year-old man had dysphagia
Irregular reddish, ulcerated exophytic mid-esophageal mass seen on mucosal
surface
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Diagnosis?
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Risk factors?
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A 57 years old man present with cough and weight loss. She
has noticed a gradual onset difficulty with swallowing both
solid and luquid food. She has been soking for the past 20 yrs
and also ingest hard liqueur. He has lost 20lbs in last few
months. Esophageal biopsy reveals presence of squamous cells
with keratin. Which is correct
A. Barret esophagus is the major risk factor
B. GERD is a common risk factor.
C. The tumour is most likely n the upper one third of the
esophagus
D. Primary ciliary dyskinesia
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A 37 years old male with frequent episodes of gastroesophageal reflux disease noticed a dramatic
improvement in the frequency and severity of her
heart burn. She consulted Dr.Blessing who ordered
endoscopy. Esophageal biopsy taken reveals the
presence of columner type epithelium with increased
Goblet cells in gastro eso junction. Which is correct
A. risk of squamous cell cancer is increased
B. it is an example of a dysplasia
C. It represents malignant transformtion
D.Risk of adeno-carcinoma is incresed
REFERENCES
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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.
PATOMA
https://www.google.com/search?q=squamous+cell+carcinoma+of+the+eso
phagus&newwindow=1&source
Robins patholgy
Dr Jeevan’s slides