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Back to Topics<<<< These are the squamous cell carcinomas because 3/4th of esophagus is covered by squamous epithelium (Adenocarcinomas originate from columnar epithelium, accanthoma also originates from columnar epithelium but some authors account that it is due to squamous cells) Definitions: Cancer is the malignant tumor of the mucous membrane or epithelial layer while Sarcoma originates from connective tissue. Incidence: It has great importance in every carcinoma:
Premalignant diseases, which promote cancer:
Cervical part-------------------------- 8% Near aortic arch ---------------------- 12% Upper thoracic ------------------------ 3% Middle thoracic ----------------------- 32% Lower thoracic ------------------------ 25% Cardiac part -------------------------- 32% Clinical features: Esophageal cancer usually occurs in advanced age. The symptoms are divided into three categories: Topical symptoms:
Are due to the compression of tumor mass to the vicinity of the located organs. The symptoms are:
Are characterized for all kinds of cancers:
When carcinoma invades only in the mucous layer, it is called intramucous invasion, if submucous invades till the muscular propia then it is called intramural invasion. If it invades through the whole thickness of esophageal wall then it is known as transmural invasion. TNM classification: T-0 ----- No tumor T-1 ----- Tumor mass less than 5cm T-2 ----- Tumor mass more than 5cm T-3 ----- Any kind like a transmural one N-0 ----- No regional lymph nodes involved N-x ----- Involvement of lymph nodes is doubtful N-1 ----- Lymph nodes are palpable, movable and unilateral N-2 ----- Movable, palpable and bilateral N-3 ----- Fixed unilateral or bilateral M-0 ----- No distant metastasis M-1 ----- Distant metastasis present Diagnosis: CT, MRI and Ultrasound examinations are useful. In TNM classification Ct and MRI informations are not sufficient because with these we can’t make the decision about movable and fixed nodes. Surgical treatment: Previous to surgery it is necessary to maintain serum protein levels because poor nutritional state, the host’s resistance to infections as well as to wound healing increases. Serum albumin level less than 3.4 dg/L indicates a poor caloric index and risk of surgical interventions. A feeding tube is inserted into jejunum via Jejunostomy, which provides the excellent results. In severely malnutrition patients, Jejunostomy must be performed as a separate procedure to prepare the patient for the pre-operational support. In these patients, abdominal cavity is opened via the little supra-umbilical incision otherwise the jejunal tube should be placed at the time of esophageal resection. Cervical Esophageal Cancer: Czerny was the first to perform this operation in 1877; with first the removal of the carcinoma from the cervical part of the esophagus but the result was dismal. In many cases surgical interventions in this part of esophagus is impossible because spreading of malignant process over the vicinity of localized organs such as trachea, vocal cords, vagal nerve (Sympathetic chain), vessels, spinal cord, cervical vertebrae et… If it is the case of respectable tumor (if there is no invasion in the nearby organs and lymph nodes are movable), ESOPHAGECTOMY must be performed. In curative measure en-block dissection of esophagus with three kinds of incisions must be done as explained in the following procedure;
This article has been written by Dr. M. Javed Abbas. If you have any comments please do not hesitate to sign my Guest Book. 21:00 21/12/2002 |