DIAGNOSIS AND MANAGEMENT ESOPHAGEAL CANCER

DIAGNOSIS AND MANAGEMENT ESOPHAGEAL CANCER DIAGNOSIS AND MANAGEMENT ESOPHAGEAL CANCER 0DIAGNOSIS AND MANAGEMENT ESOPHStAuvGiaE.cAoLm C- TAhNeCMEaRrketplace to BuyDaInAdGSNelOl ySoIuSr Study Material Introduction, definition, age, pathology –Refer. Sex M:F - 25:1 Age Average age - 58.2yrs (12-103yrs) Prevalent region - Central Nyanza province Predisposing factors Contribute to repeated long term minimal trauma a)Lifestyle 1.Smoking - SCC 2.Alcohol excess – SCC -Betel chewing b).Diet 3- Hot foods 4- Deficiency of antioxidants which have been found to inhibit carcinogenesis, including selenium, vitamins C and E, retinoids, & β-carotene, & plant sterols. 5-Exposure to N-nitroso compounds (from Nitrates & Nitrites converted by bacteria in the body) 6-Charred meat, Smoked fish C)Disorders of esophagus 7.Achalasia 8.Long standing oesophageal strictures 9.Post-irradiation 10. Paterson-Brown-Kelly (Plummer-Vinson) Syndrome - Post cricoid web + IDA 11. Barrett's oesophagus - there is a 44-fold ↑ risk of Adenocarcinoma if severe reflux for 10yrs d)Genetics 12. Tylosis (Palmar hyperkeratosis) 13. Coeliac disease - Predisposes to Adenocarcinomas 14-Epidrmolysis bullosa 15-P53 and RB genes Pathology Types; Squamous cell carcinoma- Most common worldwide Adenocarcinoma - Most common in most Westernised countries Oat cell carcinoma Site; 20% - Upper ⅓ - Squamous cell carcinoma 50% - Middle ⅓ - Squamous cell carcinoma 30% - Lower ⅓ - Adenocarcinoma Spread; 1. Local-regional - Occurs through submucosal infiltration of the wall of the oesophagus into adjacent structures, along the length of the oesophagus in the submucosal lymphatics & to regional lymph nodes. This is often discontinuous i.e. distant regional lymph nodes may be invaded even when local nodes are free of tumour, & there may be satellite nodules in the oesophagus proximal to the History Symptomatology -Progressive dysphasia initially to solids then to liquids. -Associated odynophagia- involvement of somatic structures. -Associated choking while eating-possibility of Tracheo- esophageal fistula -Hoarseness of voice-involvement of recurrent laryngeal nerve -Associated regurgitation and vomiting-colour-no bile pigment. (Due to the obstruction) -History of hematemesis or hemoptysis -Difficulty in breathing, cough-pulm. mets -Progressive weight loss, generalized fatigue and night sweats. -Steady deep chest pain often indicates mediastinal invasion. Predisposing factors. - Cigarette smoking or smoking in immediate family and alcohol intake. -ingestion of corrosive liquids-strictures -peptic ulcer and GERD-predispose adenocarcinoma -chronic drug intake-esophagitis -Consumption of chemically preserved vegetables-nitrates Smoked fish or meat -Chest irradiation-therapeutic or otherwise -cancer in patient or Family history of similar illness Physical Examination Usually non-revealing: General examination- 1. Anemia- chronic disease or Plummer Vinson syndrome Also check glositis and angular stomatitis 2. Dehydration and wasting –malnutrition 3.Oedema-malnutrition 4.Supraclavicaulr lympadenopathy-Virchows node -Examination of Chest crucial because of tumor infiltration. -Trachea central, air entry. -Resp exam-TOF creates effusion and pneumonia. INVESTIAGTIONS Laboratory 1. FHG-Anemia can be due to bleeding or nutritional deficiency or can be secondary to chronic disease and pre op preparation 2. U/E/C pre op 3. Liver function tests Serum protein levels (albumin, prealbumin, and transferrin) may be low, reflecting the extent of malnutrition. -Abnormal liver function tests may indicate liver metastases Imaging 1. Esophago