Esophageal Carcinoma PDF

ESOPHAGEAL CARCINOMA Diana Chetroiu, MD, PhD Medical Oncology and Gastroenterology Epidemiology - The incidence of esophageal cancer varies widely between regions of the world; - Is the sixth/ seventh most common cancer worldwide - High – prevalence areas include Asia and Africa Epidemi...

ESOPHAGEAL CARCINOMA Diana Chetroiu, MD, PhD Medical Oncology and Gastroenterology Epidemiology - The incidence of esophageal cancer varies widely between regions of the world; - Is the sixth/ seventh most common cancer worldwide - High – prevalence areas include Asia and Africa Epidemiology - 40% of squamous cell carcinoma develop in the middler third and 15% in upper third - Adenocarcinomas develop in the lower third of the esophagus and at the cardia and represent approximately 45% of the tumours - Incidence of scquamous carcinoma has been decreasing in Western countries as the incidence of adenocarcinoma is rising - The overall 5- years survival rate ranges from 15% to 25%, depending on the stage of the cancer at the time of initial presentation Clasification 2 histological types: squamous cell carcinoma in the upper parts of the esophagus (90%) adenocarcinoma in the distal esophagus Risk factors for adenocarcinoma - GERD - Barrett esophagus - tobacco use - obesity - after chest irradiation - diet low in vegetables and fruits - older age - male sex - use of medications that relax LES Risk factors for squamous cell carcinoma - tobacco and alcohol use - caustic injury - achalasia - human papillomavirus infection - nitrosamines exposure - past thoracic irradiation - palmoplantar keratoderma - nutritional deficiencies (Zn, Se) - poor socio-economic status Clinical manifestations - dysphagia for solid foods, the most common symptom - weight loss - iron deficiency anemia, secondary to gastrointestinal bleeding - chest pain - anorexia - upper gastrointestinal bleeding - lung complications: aspiration pneumonia, cough, hoarseness Paraclinical investigations - barium esophagography - upper endoscopy with biopsy - endoscopic ultrasonography - CT chest - PET-CT is widely used as part of standard preoperative staging - determination of the HER gene mutation 2  Barium radiography barium radiography shows stenosis of the esophageal lumen, with irregular contour, with overlying dilation of the esophagus Differential diagnosis to achalasia Achalasia  Upper endoscopy with biopsy Is the preferred diagnosis test Establishes the diagnosis reveals vegetative, ulcerative-vegetative, infiltrative-stenotic tumor formation  Endoscopic ultrasonography Is routinely used to assess the depth of tumor penetration and presence of involved lymph nodes. Staging TNM staging - CT scan - MRI - Endoscopic US - PETCT - Laparoscopy Treatment Curative: surgical in localized disease esophagectomy preoperative chemotherapy increases survival chemotherapy plus preoperative radiation therapy Treatment Treatment for advanced disease Chemotherapy combined with radiation therapy 5 fluorouracil, cisplatin Targeted therapy antiHER2 therapy Immunotherapy Palliative therapy ( nutritional support, pain management) Other oesophageal tumours Gist Leiomyomas Kaposi sarcomas