Esophageal Carcinoma - L14 Notes PDF

iS1/11. Esophageal carcinoma -old male , cancer...

iS1/11. Esophageal carcinoma -old male , cancer esophagus Progressive dysphagia, Cancer esophagus age intermittant dysphagia achalasia Key: Middle age female cachalasia s A MCQ Old age cachectic male (smoker, alcoholic) with progressive dysphagia. why progressive ?? lumen 11 1jl Massis obstructionsldj =S. & JSg progressive - Sl , ) eventually the Pt may reach a state where he can't swallow his own saliva => leaking drowing of saliva to Predisposing factor: A 1- Chronic irritation: Spicy foods, Smoking & Spirit (Alcohol). 8 - & Metaplasia acid 11 esophagus 110 is / unstable cells it 2- Barrett’s esophagus (premalignant).Complication of GERD. premalignant as ① a Pt know to have Barrett's esophagus 3- Achalasia of esophagus. If long standing. developed adenocarcinoma cancer, what is the Microscopic pic ? A squamous cell carcinoma XXX (5 = 8 198 4 Post corrosive esophageal stricture. transitional cell , , C carcinoma XXX 6 &- Jubil g That is why adenocarcinouce is More common in the lower third while squamous cell carcinoma is 5 Benign tumors: papilloma or adenoma. , More common in the uppert Middle thirds Benign , Malignant transformation MCQ I Adenou > Adenocarcinoma Pathology: What Q are the 3 premalignant lesions for cancer esophagus ?? z papillowc , squamous cell carcinoma I Barrette's esophagus a achalasia Site (% increases by getting down) 3 post-corrosive esophagitis and the reasone is that the GERD effect more the lower esophagus cause The lower third is the most common site now (Barrett) s MCQ  Q a Pt known to have intestinal cancer, presented with intestinal obstruction which of the following is most likely the Macroscopic picture of his tumor ? protrude fugating Ms => into lumen Macroscopic (Gross Picture): XXX * only involve the wall  Infiltrating mass. infiltrate the wall itself, we would find it within the wall lumen 14. adog Typeso likely Not to cause obstruction cancers  Ulcerative mass. edge everted , Necrotic floor endurated fixed base , , enlarged LN , delayed healing  Cauliflower mass. fungating · mass = polypoided mass u mass protruding into the humen fugating infiltrativ Microscopic picture:  Squamous cell carcinoma: 40% from upper 2/3.  Adenocarcinoma: 60% from lower 3 cm or on top of Barrett’s esophagus. carcinoma s lymphatic spread Blood spread Sarcoma, Blood Spread Lymphatic spread Spread: (Direct, Lymphatic, Blood & Trans-coelomic) esophageal cancer is carcinoma spread is so ymphatic More than Blood 1- Direct spread: Most dangerous to adjacent structures (trachea, recurrent laryngeal nerve, lungs, pleura or aorta). fatal form tracheoesophageal fistula Malignant Sistules lead bleeding to 2 Lymphatic spread: early. a. Cervical esophagus to deep cervical LNS. b. Thoracic esophagus to mediastinal LNS. c. Abdominal esophagus to celiac LNS. layers of the esophagus 3 Blood spread: rare and late. : mucosa , submucosai Muscularis, adventifia Mainly to liver and lung. & No Serosc or So , the esophagus doesn't send transperitoneal spread except the lower abdominal part MCQ 4 Trans-coelomic: = transperitoneal spread I happen in Only in abdominal esophagus e.g. krukenburg tumor to the ovaries. any organ in the peritoneum &↓ speritoneum/l & %./1g 2 Bilateral 5817048 g of transcoelemic spread 1916 ~ Most common hoy tumor esophagus/ g/ sig) 15 4 carcer / of related peritoneum esophagus stomach colon. to ↳ abdomina part 301bljj.. any organ , , , pancrease.... Not specific to esophagus  2 other than that : Cancer May send mets to the most dependant abdominal structures: Doglus pouch reclovesical pouch Clinical picture: Blumer's shelf 11 per rectal exam 14j , i Cry spread of intraperitoned tumors to doughs pouch Rectoresiced + Poud this sign is Not specific to esophagus Symptoms: Old age male Cachectic with: More Sje Main Symptom 1 Dysphagia: rapidly progressive, to solids > fluids, but later the patient cannot swallow his own saliva leading to continuous drippling of saliva. of Because the Mass is hemorrhagic mass , with areas hemorrhage and necrosis 2 Regurgitation (blood stained): leads to pulmonary symptoms. (Aspiration pneumonia & repeated chest infections). 3- Excessive salivation. 4 Loss of appetite and weight loss (Cancer Cachexia). 4 Symptoms due to infiltration of adjacent structures: E.g. change of voice due to infiltration of RLN. Signs: General:  Cachexia & weight loss. lymphatic drainage of the body end by 2 ducts :  Dehydration. N RE lymphatic duct bring lymph from Rt upper body Thoracic duct bring lymph from the whole body except  Chest infection. the R body 2 upper The Rt Symphatic duct go and end at the thoracic duct and the thoracic ductend at the left brachiocephalic vein Local: Bloodh 110Symph 11 , t Bose  Neck: for presence of lymph enlarged Lt supraclavicular LN virchow LN Ggli nodes (Virchow's node). What is advancedas I vib , > s Metastasis (e) jg 2 the name of this sign? Is it specific? What is the prognosis?  Abdomen: for palpable hard nodular liver (metastasis) and malignant ascites. & LN Maure : Virchow LN 1- Trousseau's sign for latent tetany positive in the setting of hypocalcemia.The sign is observable as a carpopedal spasm versig prognosis induced by ischemia 3 2- Chvostek's sign (twitching of facial muscles in response to tapping over the facial nerve 3- Courvoisier's law: in case of obstructive jaundice with enlarged palpable gall bladder it is most likely to be malignant 4- Troisier's sign is the finding of a palpable left supraclavicular lymph node 5- Trousseau sign of malignancy, is described as thrombophlebitis that travels, often from one leg to the other Courvoisier'slaw has exceptions.. Malignancy without enangment presence of stons by coincidence or surgically removed ge bladder or congenitally absent, or the Malignancy is within the supraduodened part of biliary tree Klatskin tumor" The most difinitive for laproscope t Biopsy & stone causing enlargement as first attack Investigations: managment investigation any cancer is & cancer colon colonoscope + Biopsy & cancer stomach Laparoscope + Biopsy a cancer esophagus - upper endoscopy t Biopsy a. For diagnosis:  Esophagoscopy and biopsy. [ ifugating Mass  Barium swallow (Rat tail appearance &shouldering ). - +; > Mass int & 5501 s -5-53 - i jast Rut tail = J appearance S Barium Swallows I cancer esophagus Shouldering+Ret tail 2 achalasia , purrot peak appearance 3 Zenker's diverticulum paraesophaged pouch b. For staging :  Endo-luminal U/S. to determine degree of infiltration.  CXR. For lung nodules.  CT scans (neck, chest & abdomen).  Bronchoscopy. For trachea & bronchi infiltration. to check for Malignant fistula 4  Treatment: Most cases are inoperable at time of presentation -fit Pt , Mass Not invading the adjacent stuctures , No vascular invasion , eve Metastatio workup Operable tumors: Surgery: Nowadays many surgeons prefer to do : Trans-hiatal total esophagectomy. NB: Adjuvant treatment (chemo-radiotherapy) can be effective with surgery especially with squamous cell carcinomas. The idea of the surgery , is to work through I surgiced openings without opening the thorax. They do a cerviced incision i s ess + transhiatal incision at Tos free idesophagus (18- & I /114. -a ·46%.ge The problem of this Thequedonis ar surgery is : we are working BlindlySo , we May injure Many structures I as azygous themriazygous severe Bleeding leading to urgent thoracotoury to the sleeve Tubers o 19 case Injury to the membranous tracke posterior wall of trachen death so , always be carefull in disecting Necks's i , ji esophagent Anterior wall it better for the anastamosis to be at the Ned chest ?? Neck of the following is or which is the Most dangerous during Anterior wall Because leaks at the chest directly lead to Mediastinitis dissection during esophagectomy ? While in the neckThere will be early detection of any leasage fatal + leakage there isn't -S > as Brain or liver Metastasis m 1 Bypass: Gastric or Colon bypass. li e 51 : 1 jen. 0. permenant dysphagig  GERD (or) GORD Definition: Reflux of acid juice (gastric contents into the lower part of the esophagus). Causes: Sliding hiatus hernia is the most common cause. IMPORTANT. (Plus any factor causing an increase in intra-abdominal pressure). causes relaxation Pathology: ‫مهم‬ Belsy`s endoscopic grading of reflux: Grade 1: Hyperemic mucosa. Grade 2: Intermittent superficial ulcers. Grade 3: Extensive ulceration. Grade 4: Stricture or Barrett`s esophagus. Clinical picture: Symptoms: I lying down gastric clearance because 1 Heart burn (retrosternal): ↑ by lying flat and ↓ by standing upright. 2 Regurgitation: especially on lying down, relieved by sitting. 3 A Sour taste in the mouth. 4 Dysphagia due to esophageal spasm at first, but later due to stricture formation. 4 Symptoms of complications (late): Aspiration pneumonia. Not viral it due to recurrent GERD Hoarseness of voice (Laryngitis). ~ , is ENT consultant that diagnose Barrett`s esophagus. the in Many cases is one GERD with these when presented typical symptons Signs: General: − Bad nutritional state. − Anemia. − Chest infection. Most diagnostic tests Investigations: : I cancer esophagus(upper GI endoscopy + Biopsy 2 achalasia , Manometer a- For diagnosis: 1. Instrumental : Monitoring 3 GERD