Atlas of pathophysiology, 2 Edition

Part II - Disorders

Gastrointestinal Disorders

Esophageal Cancer

Esophageal cancer is usually fatal. This disease occurs worldwide, but incidence varies geographically. It's most common in Japan, China, the Middle East, and parts of South Africa. Common sites of distant metastasis include the liver and lungs.

Age Alert

Esophageal cancer most commonly develops in men over age 50.

Causes

Unknown

Predisposing factors

·         Chronic irritation by heavy smoking and excessive use of alcohol

·         Stasis-induced inflammation as in achalasia or stricture

·         Nutritional deficiency

·         Diets high in nitrosamines

·         Previous head and neck tumors

Pathophysiology

Esophageal cancer includes two types of malignant tumors: squamous cell carcinoma and adenocarcinoma. Most esophageal cancers are poorly differentiated squamous cell carcinomas. Adenocarcinomas are less frequent and are contained to the lower third of the esophagus. Esophageal tumors are usually fungating and infiltrating, and they partially constrict the lumen of the esophagus.

Regional metastasis occurs early by way of submucosal lymphatics, often fatally invading adjacent vital primary organs.

Signs and symptoms

·         Anorexia

·         Vomiting

·         Dehydration

·         Regurgitation of food

·         Dysphagia and weight loss (most common)

·         Esophageal obstruction

·         Pain

·         Hoarseness, coughing

·         Cachexia

Complications of metastasis

·         Tracheoesophageal fistulas

·         Mediastinitis

·         Aortic perforation

·         Aspiration pneumonia

·         Inability to control secretions

Diagnostic test results

·         X-rays of the esophagus, with barium swallow and motility studies, delineate structural and filling defects and reduced peristalsis.

·         Computed tomography shows size and location of esophageal lesions.

·         Magnetic resonance imaging permits evaluation of the esophagus and adjacent structures.

·         Esophagoscopy, punch and brush biopsies, and exfoliative cytologic tests confirm esophageal tumors.

·         Bronchoscopy, usually performed after an esophagoscopy, reveals tumor growth in the tracheobronchial tree.

·         Endoscopic ultrasonography of the esophagus combines endoscopy and ultrasound technology and reveals the depth of penetration of the tumor.

Treatment

·         Usually multimodal

·         Resection to maintain a passageway for food

·         Palliative treatments

§  Feeding gastrostomy and chemotherapy

§  Insertion of a prosthetic tube and chemotherapy

§  Dilation of the esophagus

·         Analgesics

P.175

COMMON ESOPHAGEAL CANCERS

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