LearningRadiology- Ca of Esophagus

Carcinoma of the Esophagus

• Predisposing factors

• Men>women

• Achalasia (polypoid mass in middle or distal third)

• Asbestosis

• Plummer-Vinson syndrome (iron deficiency anemia, webs)

• Barrett esophagus (columnar metaplasia of the distal esophagus 2° chronic GE reflux)

• Celiac disease

• Lye stricture

• Alcoholism

• Smoking

• Prior radiation

• Oral/pharyngeal cancer

• Tylosis palmaris-hyperkeratosi of the palms and the soles

• Squamous cell ca (95%)

• Adenocarcinoma arising from heterotopic gastric mucosa or columnar-lined epithelium (Barrett’s)

• Carcinosarcoma=spindle-cell carcinoma

• Location usually middle third of esophagus

• Large, bulky, polypoid intraluminal mass which may be pedunculated

• Mucoepidermoid carcinoma

• Spread is facilitated by the esophagus’ lack of a serosa

• Dysphagia

• Weight loss

• Retrosternal pain

• Regurgitation

· Polypoid/fungating form (most common)

Sessile, polyp

Apple-core lesion

· Ulcerating form

Large ulcer within mass

· Infiltrating form

Gradual narrowing resembling benign stricture

· Varicoid form=superficial spreading carcinoma

Thickened nodular folds looks like varices

• Squamous cell carcinomas of the distal esophagus almost never invade the stomach whereas adenocarcinomas arising from a Barrett’s does

• To lymphatics-especially supraclavicular nodes

• Hematogenous: lung, liver, adrenal

• About 5-10% of patients with esophageal ca will develop esophageal-airway fistulae, frequently following XRT

• 3-20% 5 year survival

wh/93