R.Vignesh

Oesophageal Tumours

BENIGN NEOPLASMS

Leiomyoma (MC ,accounts for 2/3 rd of all benign neoplasms)

Mucosal Polyps Lipomas Neurofibroma Fibromas Lymphangioma Haemangiomas

LEIOMYOMA

Endoscopic view Barium swallow

It is a smooth muscle tumour.

Ovoid filling defect

Submocosal swelling

SURGICAL REMOVAL

Thoracotomy VATS

Mucosal Polyps Lipoma

RISK FACTORS Heavy Smoking Alcohol Consumption Dietary Habits (intake of food contaminated

with fungus) Nutrional Deficiency,Coeliac diseae HPV infection About 5% cancer arises from pre-existing

pathological lesions1. Oesophagitis (Barrett’s oesophagus in case

of adenocarcinoma)2. Achalasia3. Hiatus hernia4. Plummer-Vinson Syndrome

BARRET’S OESOPHAGUS

Squamous Epithelium Columnar Epithelium

CARCINOMA OF OESOPHAGUS

There are various subtypes

 Squamous cell carcinoma (approx 90–95% of all esophageal cancer worldwide) Squamous cell cancer arises from the squanous epithelium that lines the upper part of the esophagus.

 Adenocarcinoma (approx. 5-10% of all esophageal cancer). Adenocarcinoma arises from glandular cells that are present at the junction of the esophagus and stomach.

DISTRIBUTION OF OCCURENCE

SQUAMOUS CELL CARCINOMA

1.Arises from the squamous epithelial lining of the oesophagus

2.Most common in men than women

3.Disease occurs more commonly in the 6th to 7th decade of life

TYPES

ADENOCARCINOMA

1. More common in males

2. It occurs in 4th to 5th decade of life

3. It has nodular and elevated appearance

METASTASIS Direct. The lesion may fill the lumen and

infiltrate the wall of oesophagus. It may also spread to the adjoining structures such as the trachea, left bronchus, aorta or pericardium. Involvement of the recurrent laryngeal nerves causes aspiration problems.

Lymphatic. Depending on the site involved, cervical, mediastinal or coeliac nodes may be involved. Cervical and thoracic lesions also spread to supraclavicular nodes. "Skip lesions" may also occur due to spread through the submucosal lymphatics.

Blood borne. Metastases may develop in the liver, lungs, bone and brain.

SIGNS & SYMPTOMS

Early symptoms include substernal discomfort and preference for soft or liquid food.

Progressive dysphagia and emaciation. Dysphagia first to solids and then to liquids. Patient loses weight and becomes emaciated.

Pain. Usually signifies extension of tumour beyond the walls of oesophagus.

Aspiration problem. Spread of cancer may cause laryngeal paralysis or fistulae formation leading to cough, hoarseness of voice, aspiration pneumonia and mediastinitis

DIFFERENTIAL DIAGNOSIS

Foriegn Body Benign Strictures of oesophagus Globus Pharyngeus Cricopharyngeal spasms Achalasia (Bird beak/ Rat tail appearance in

Barium swallow)

CLINICAL EVALUATION

Barium swallow shows narrow and irregular oesophageal lumen, without proximal dilatation of the oesophagus

Oesophagoscopy. Useful to see the site of involvement, extent of the lesion, and to take biopsy. Flexible fibre optic oesophagoscopy obviates the need for general anaesthesia and gives a magnified view.

CT scan is useful to assess the extent of disease and nodal metastases

Coronal view

TREATMENT Surgery of upper two-thirds of oesophagus is

difficult due to great vessels and involvement of mediastinal nodes. Radiotherapy is the treatment of choice

Surgery is the preferred method of treatment for cancer of lower one third. The affected segment, with a wide margin of oesophagus proximally, and the fundus of stomach distally, can be excised with primary reconstruction of the food channel

(iii) Oesophageal intubation with Celestin or Mousseau-Barbin or a Atkinson tube to provide an alternative food channel .

(iv) Laser surgery: Oesophageal growth is burnt with Nd: YAG laser to provide a food channel. Chemotherapy is used only as a palliative measure in the locally advanced or disseminated disease.

PROGNOSIS

In India ,oesophageal cancer constitutes 3.6% of all body cancers in the rich and 9.13% of those in the poor

Five-year survival is not more than 5-10%.