Esophageal CA

7/29/2019 Esophageal CA

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ESOPHAGEAL CANCER

Esophageal cancer is a cancerous(malignant) tumor of the esophagus, the

muscular tube that moves food from the

mouth to the stomach.

Esophageal cancer can be of two cell type:

adenocarcinoma and squamous cell

carcinoma.


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PATHOPHYSIOLOGYRisk factor:

Chronic ingestion of hot liquids or food , GERD, Nutritional deficiency,

Barretts esophagus, Poor oral hygiene, Cigarette smoking

Adenocarcinoma squamous cellcarcinoma

Cancer cell arise from the surface area of esophagus

Chronic esophageal irritation/ tumor

Dysphagia

Sensation mass in throat

Painful swallowingSubsternal pain or fullness

Regurgitation of undigestive food

Obstruction of esophagus


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STAGING/GRADING

Staging of squamous cell carcinoma of theesophagus

Stage 0: This is the same as Tis cancer, in

which cancer is found in only the top lining ofthe esophagus (Tis, N0, M0, G1)

Stage IA: This is the same as T1 cancer, in

which the cancer is located in only the twoinside layers of the esophagus. (T1, N0, M0,

G1)


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Stage IB: Either of these two conditions:

The cancer is located in only the two inside

layers of the esophagus, but the tumor cells

are less differentiated (T1, N0, M0, G2 or G3)

The tumor is located in the lower part of the

esophagus, and the cancer has spread to

either of the two outer layers of the

esophagus, but not to the lymph nodes orother parts of the body. (T2 or T3, N0, M0,

G1)


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Stage IIA: Either of these two conditions:

The tumor is located in the upper or middle

part of the esophagus, and the cancer is ineither of the two outer layers of theesophagus. (T2 or T3, N0, M0, G1),

The tumor is located in the lower part of theesophagus, and the cancer is in either of thetwo outer layers of the esophagus. The tumorcells are less differentiated. (T2 or T3, N0,

M0, G2 or G3)


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Stage IIB: Either of these two conditions:

The tumor is located in the upper or middlepart of the esophagus, and cancer is in either

of the two outer layers of the esophagus. The

tumor cells are less differentiated. (T2 or T3,N0, M0, G2 or G3),

Cancer is in the inner layers of the

esophagus and has spread to one or twolymph nodes near the tumor. (T1 or T2, N1,

M0, any G)


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Stage IIIA: Any of these three conditions:


esophagus and has spread to three to six

lymph nodes near the tumor. (T1 or T2, N2,

M0, any G)

Cancer is in the outside layer of the

esophagus, with involvement of one or two

lymph nodes. (T3, N1, M0, any G)

Cancer has spread beyond the esophagus to

nearby tissue, but no spread to lymph nodes

or other areas of the body (T4a, N0, M0, any

G)


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Stage IIIB: Cancer is in the outside layer of theesophagus and in three to six lymph nodes. (T3,N2, M0, any G)

Stage IIIC:Any of these three conditions: Cancer has spread beyond the esophagus into

nearby tissue. Cancer is also in six or lesslymph nodes. (T4a, N1 or N2, M0, any G)

Cancer has spread beyond the esophagus intonearby tissue, but cannot be removed bysurgery. (T4b, any N, M0, any G)

Cancer involves seven or more lymph nodes,but has not spread to distant parts of the body.(any T, N3, M0, any G)


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Stage IV: Cancer has spread to another partof the body (any T, any N, M1, any G)

Staging of adenocarcinoma of theesophagus

Stage 0: This is the same as Tis cancer, in

which cancer is found in only the top lining ofthe esophagus (Tis, N0, M0, G1)

Stage IA: This is the same as T1 cancer, in

which the cancer is located in either of thetwo inside layers of the esophagus only. (T1,

N0, M0, G1 or G2)


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Stage IB: Either of these two conditions:

The cancer is located in either of the two

inside layers of the esophagus only, and the

tumor cells are poorly differentiated (T1, N0,

M0, G3),

The cancer has spread to an outer layer of

the esophagus, but not to the lymph nodes or

other parts of the body. (T2, N0, M0, G1 or

G2)


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Stage IIA: Cancer is in an outer layer of theesophagus, and the cells are poorly

differentiated. (T2, N0, M0, G3)

Stage IIB: Either of these two conditions:

Cancer is in the outside layer of theesophagus, but not beyond. (T3, N0, M0, any

G)

Cancer is in an inner layer or the muscularis

propria of the esophagus, and involves one

or two lymph nodes. (T1 or T2, N1, M0, any

G).


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Stage IIIA: Any of these three conditions:


esophagus and has spread to three to sixlymph nodes near the tumor. (T1 or T2, N2,M0, any G), or

Cancer is in the outside layer of theesophagus, with involvement of one or twolymph nodes. (T3, N1, M0, any G), or

Cancer has spread beyond the esophagus tonearby tissue, but there is no spread tolymph nodes or other areas of the body (T4a,N0, M0, any G)


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Stage IIIB: Cancer is in the outside layer of theesophagus and in three to six lymph nodes. (T3,N2, M0, any G)

Stage IIIC:Any of these three conditions: Cancer has spread beyond the esophagus into

nearby tissue. Cancer is also in six or lesslymph nodes. (T4a, N1 or N2, M0, any G)

Cancer has spread beyond the esophagus intonearby tissue, but cannot be removed bysurgery. (T4b, any N, M0, any G)

Cancer involves seven or more lymph nodes,but has not spread to distant parts of the body.(any T, N3, M0, any G)


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Stage IV: Cancer has spread to another partof the body (any T, any N, M1, any G)

Recurrent: Recurrent cancer is cancer thatcomes back after treatment. It may come

back in the esophagus or in another part of

the body.


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CLINICAL MANIFESTATION

Many of patients have an advanced ulceration

lesion of the esophagus before symptoms is

manifested.

Symptoms include dysphagia, initially solidfoods and eventually with liquids, a sensation of

a mass in the throat, painful swallowing,

substernal pain of fullness, and, later,regurgitation of undigested food with foul breath

with hiccups.


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The patient first becomes aware of

intermittent and increasing difficulty in

swallowing.As the tumor grows and the obstruction is

nearly complete, even liquids cannot pass

into the stomach.Regurgitation of food and saliva occurs,

hemorrhage may take place, and the

progresses loss weight and strengthoccurs from inadequate nutrition.


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Later symptoms include substernal pain,

persistent hiccup, respiratory difficulty, and

foul breath.

The delay between the onset of early

symptoms and the patient seeking medical

advice is often 12 to 18 months.

Any person having difficulty swallowing

difficulties should be encouraged toconsult physician immediately.


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MEDICAL MANAGEMENT

Treatment may include surgery, radiation,chemotherapy, or combination of thesemodalities depending on the type ofcancer cell, the extent of the disease, and

the patient cancer includes the following:

preoperative combination chemotherapyand radiation therapy for 4 to 6 weeks;

followed by no medical intervention for 4weeks;


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lastly surgeon resections of the

esophagus.Standard surgical management includes

the total resection of the esophagus

(esophagectomy) with removal of tumorplus a wide tumor margin of the

esophagus and the lympnodes in the area.

The surgical approach maybe through the

thorax or the abdomen, depending on the

location of the tumor.


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When the tumor occur in the cervical or

upper thoracic area, esophageal

continuity maybe maintained by a free

jejuna graft transfer, in which the tumor

removed and the area is replaced with a

portion of jujenum.A segment of a colon maybe used, or the

stomach can be elevated into the chest

and the proximal section of the esophagusanastomosed to the stomach.


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NURSING MANAGEMENT

Assessment

Asses the patient for backwards movement

of food through the esophagus and possibly

mouth (regurgitation), chest pain unrelated toeating difficulty swallowing solids or liquids,

heartburn, vomiting blood, weight loss


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Diagnosis

Imbalanced nutrition, less than bodyrequirements, related to difficulty swallowing

Risk for aspiration related to difficultyswallowing or to tube feeding

Acute pain related to difficulty swallowing,ingestion of an abrasive agent, tumor, orfrequent episodes of gastric reflux

Deficient knowledge about the esophageal

disorder, diagnostic studies, medicalmanagement, surgical intervention, andrehabilitation


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Planning

The major goals for the patient mayinclude attainment of adequate nutritional

intake, avoidance of respiratory

compromise from aspiration, relief of pain,and increased knowledge level


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Nursing Interventions

Encouraging adequate nutritional intake

Decreasing risk of infection

Relieving pain Providing patient Education


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ESOPHAGEAL

CANCER

PREPARED BY:

CHARLES JO FRITZ MACALDEDOMINIC ROY PANES

LONA GRACE TRIBUNSAY

CHRISTY PADERNILLA

SUBMITTED TO:

MRS. FAITH FRANCES L. LIBARIOS, R.N.

Esophageal CA

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