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ESOPHAGEAL CANCER
Group 7 members
Hardy Ward, Scarla Colon,Nehe Bah
Dharam Bhagwandas,Jennifer Moreta,Adam Hernandez
What is Esophageal Cancer?
-Cancer that forms in tissues lining the esophagus.
Two types of esophageal cancer are:
1. Squamous cell carcinoma
-cancer that begins in flat cells lining the esophagus
(squamous cells)
* often found in the upper and middle part of the
esophagus
2. Adenocarcinoma
-cancer that begins in cells that make and release
mucus and other fluids called glandular cells
*Adenocarcinomas usually form in the lower part of
the esophagus, near the stomach.
CAUSES
-Tobacco use.
-Heavy alcohol use.
-Barrett esophagus -A
condition in which the cells lining the lower part of the esophagus
have changed or been replaced with abnormal
cells that could lead to cancer of the esophagus.
-Gastric reflux (the backing up of stomach contents into the lower
section ofthe esophagus) may irritate the esophagus and, over time,
cause Barrett esophagus.
-Older age.
-Being male.
DIAGNOSIS
-Physical exam and history
-Chest x-ray
-Barium swallow
-Esophagoscopy-which is a procedure where an esophagoscope is
inserted through the mouth or nose and down the throat into the
esophagus
-Biopsy- which is the removal of cells or tissues so they can be
viewed under a microscope
Patient History
• Female 75 years old
• Had breast cancer that metastasized into her
esophagus causing for the removal and replacement of
the esophagus.
• Ivor- Lewis Esophagectomy is the removal of the
esophagus and part of the stomach.
• Had a gastric pull through where parts of her stomach
and small intestine were used to make connection to
allow swallowing
• A subsequent esophagram was ordered on (7/2/2013)
to compare with a previous one from 6/19/2013
The Esophagus -which is a
hollow organ that carries food
and liquids from the throat to
the stomach.
-The walls of the esophagus
contain two sphincter; the
Upper Esophageal Sphincter
and the Lower Esophageal
Sphincter.
The Upper Esophageal
Sphincter (UES) is a muscle
that controls
1. Breathing
2.Belching
3.Vomiting
4. Keeping food and liquid
from going down the
windpipe
ANATOMY
ANATOMY CONTINUED..
The Lower Esophageal Sphincter (LES) prevents
1. acid and food contents from moving back up to the
esophagus
The wall of the esophagus has several layers that are important
for understanding where cancers in the esophagus tend to start
and how they grow. The layers are
1.Mucosa
2.Submucosa
3.Muscularis Propria
4.Adventitia
ANATOMY CONTINUED
-The mucosa layer contains a
part called the Epithelium.
-The Epithelium forms the
innermost lining of the
esophagus and is normally
made up of flat, thin cells
called Squamous cells.
-Most cancers of the
esophagus start in the
squamous cells.
NORMAL
VS.
CANCEROUS
Exam Procedure
An esophagram was performed on this patient, under
fluoroscopy.
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No food 12 hours before study
Patient was draped and brought to a prepared room
Patient was placed in an AP upright position for floro
A single contrast study was performed by swallowing barium
sulfate suspension
Floro was performed on a lateral to visualize the side and then
finished with floro in the RAO position
NOTE:
Equipment used was a GE legacy machine
As for technical factors, floro time was 2 min and 29 sec
yielding a dose of 863.5 cGy *cm square
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Radiographic Findings
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Preliminary radiograph
Trace bilateral pleural effusion
Mild basilar atelectasis
A left PICC line terminating in the SVC
Multilevel discogenic degenerative disease of the thoracic and
upper lumbar spine
Swallowing : normal
Mucosal surface: normal within thorax
Structural abnormality:
Status post esophagectomy
No stricture,diverticula, or any other abnormality
Emptying: mild delayed emptying from the stomach into the
small bowel
Note: no significant change
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BEFORE
AFTER
Surgical clips on
mediastinum in order to
raise part of stomach
and small intestine for
the replacement of the
esophagus
TREATMENTS
-The options are Surgery,Radiation Therapy,Chemotherapy, or a
combination of these.
These therapies depends on
1. Location of cancer
2.Whether the cancer has spread to lymph nodes
3.Patients overall health
-The Chemotherapy and Radiation, may be used to shrink the
tumor and make surgeries easier to perform.
-If the patient is too ill to have major surgery or the cancer has
already spread to another site, these procedures can be used to
reduce symptoms. This is called Palliative Therapy.
SUMMARY
Esophageal cancer is a medical condition that can be
treated and prevent if found at an early stage. Postoperative
people can still have many complications like anastomotic leak,
mediastinitis (infection of the mediastinum) atelectasis,
pneumonia, adult respiratory distress syndrome, myocardial
infarction, pericardial tamponade (blockage), hernia, obstruction,
reflux esophagitis and ulceration.The recovery may be a long
period of time, although the commitment to therapies and
following doctor’s advices could be the key to return to a healthy
lifestyle.
REFERENCES
1.Das A. Tumors of the esophagus. In: Feldman M, Friedman LS, Brandt LJ, eds.
Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA:
Elsevier Saunders; 2010: chap 46.
2.National Cancer Institute: PDQ Esophageal cancer treatment. Bethesda, MD: National
Cancer Institute. Date last modified 2/1/2013. Available at:
http://www.cancer.gov/cancertopics/pdq/treatment/esophageal/HealthProfessional.
Accessed February 4, 2013.
3.National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in
Oncology (NCCN Guidelines): Esophageal and esophagogastric junction cancers.
Version 2.2012. Available at
http://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf. Accessed February
4, 2013.
4.Sugarbaker DJ, Jaklitsch MT, Liptay MJ: Thoracoscopic staging and surgical therapy
for esophageal cancer. Chest 107 (6 Suppl): 218S-223S, 1995.
5.(n.d.). Retrieved from http://www.webmd.com/digestive-disorders/picture-of-theesophagus
6.(n.d.). Retrieved from
http://www.cancer.org/Cancer/EsophagusCancer/DetailedGuide/esophagus-cancerstaging