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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

Histology

            • 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

Symptoms

      • Dysphagia

      • Weight loss

      • Retrosternal pain

      • Regurgitation

Location

Upper 1/3

20%

Middle 1/3

50%

Lower 1/3

30%

Radiologic types

·       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

Metastases

      • 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

Prognosis

            • 3-20% 5 year survival

 

wh/93

 

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