Download Esophageal Cancer

Esophageal Cancer
• The principal histologic types of esophageal
cancer are squamous cell carcinoma and
adenocarcinoma
Etiology
• cigarette smoking and chronic alcohol
exposure as the most common etiologic
factors for squamous cell carcinoma.
• High body mass index, GERD, and resultant
Barrett esophagus are often the associated
factors for esophageal adenocarcinoma
• Nutritional deficiencies have been recognized
as contributing factors. In high-risk regions
such as parts of China and Iran, deficiencies in
vitamins (eg, riboflavin) or micronutrients may
play a role in causation.
other factors may promote esophageal
cancer
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Caustic injuries
Certain foodstuffs
Drinking hot liquids
Environmental contributors (eg, nitrosamines
in soil)
• Certain fungi, molds, or yeasts
• Acquired conditions (eg, achalasia)
• Helicobacter pylori infection, which can cause
stomach cancer, has not been associated with
esophageal cancer
History
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Dysphagia,
Weight loss
Bleeding
Pain may be felt in the epigastric or
retrosternal area;
• Hoarseness
• Persistent cough
• Respiratory symptoms
Physical examination
• Physical examination findings in patients with
esophageal cancer are typically normal, unless
the cancer has metastasized to neck nodes or
the liver.
Approach Considerations
• The goals of the workup are to establish the
diagnosis and to stage the cancer.
• Esophagogastroduodenoscopy allows direct
visualization and biopsies of the tumor
• For early-stage esophageal cancer, CT of the
chest and abdomen is an optional test for
staging
• For early-stage esophageal cancer, PET is an
optional test for staging. For locoregionalized
esophageal cancer, PET is a recommended test
for staging
• Endoscopic ultrasonography (EUS) is the most
sensitive test for determining the depth of
tumor penetration (T staging) and the
presence of enlarged periesophageal lymph
nodes (N staging)
Contraindications to surgery include
the following
• Metastasis to N2 nodes (ie, cervical or
supraclavicular lymph nodes) or solid organs
(eg, liver, lungs)
• Invasion of adjacent structures (eg, the
recurrent laryngeal nerve, tracheobronchial
tree, aorta, pericardium)
• A forced expiratory volume in 1 second of less
than 1.2 L and a left ventricular ejection
fraction of less than 0.4 are relative
contraindications to the operation.
• Chemotherapy and radiotherapy for
esophageal cancer are delivered
preoperatively.
• No survival benefit is obtained when radiation
and chemotherapy are administered
postoperatively; however, postoperative
continuance of chemotherapy started
preoperatively may be beneficial
Prevention of Esophageal Cancer
• For squamous cell carcinoma, prevention consists
of smoking cessation, efforts to reduce alcohol
abuse, and consumption of a diet containing an
adequate amount of fruits, vegetables, and
vitamins
• For esophageal adenocarcinomas, prevention
involves stopping the sequence of events leading
from gastroesophageal reflux disease (GERD) to
Barrett esophagus to adenocarcinoma.