Esophageal carcinoma

Esophageal carcinoma

The frequency is 5-7% among all diseases with malignant tumors. More often (75%) men are ill.

Risk factors

• • Smoking (increases the risk of developing the disease by 2-4 times)
  • Alcohol abuse (12 times)
  • geographic factors. The incidence of carcinomas is 400 times higher in some parts of China and Iran, which is believed to be due to the inclusion in the diet of a large amount of pickled foods, nitrosamines, mold fungi and a reduced dietary intake of selenium, fresh fruits and vegetables
  • Vitamin deficiency, especially A and C
  • Alkali burn (even after many years of exposure)
  • Achalasia. The risk of subsequent development of carcinoma is 10%
  • Berrett’s esophagus can cause adenocarcinoma in 10% of patients. pathological anatomy
  • Type of
  • The most commonly found form is squamous cell carcinoma.
  • On the 2nd place in frequency is adenocarcinoma, most often developing in patients with Berrett’s esophagus.
  • Rare tumors of the esophagus – mucoepidermoid carcinoma and adenocystic carcinoma
  • Form of tumor growth
  • Exophytic form (nodular, villous, warty)
  • Endophytia (ulcerative) form
  • Sclerosing (circular form)
  • Features of metastasis
  • Cancer of the cervical esophagus. Characterized by early metastasis to the mediastinum, cell spaces of the neck, supraclavicular regions
  • Cancer of the thoracic esophagus metastasizes along the lymphatic spaces of the submucosa of the esophagus, to the lymph nodes of the mediastinum and within the esophageal tissue.
  • Cancer of the lower esophagus metastasizes to the lymph nodes of the upper lesser omentum
  • All localizations are characterized by Virchow’s metastases in the left supraclavicular region (with advanced forms)
  • Distant metastases – in the liver (20%), lungs (10%), bone system, brain. TNM classification (see also Tumor, staging)
  • T0 – no manifestation of the primary tumor
  • Tis – preinvasive carcinoma (cancer in situ)
  • T, – a tumor with a length of up to 3 cm along the esophagus
  • T2 – tumor 3-5 cm long
  • T3 – tumor 5-8 cm long
  • T4 – tumor more than 8 cm long. Clinical classification by stages
  • I – a clearly demarcated small tumor that grows only in the mucous and submucosal membranes, does not narrow the lumen and slightly impedes the passage of food; no metastases
  • II – a tumor that grows into the muscular membrane, but does not go beyond the wall of the esophagus; significantly disrupts the patency of the esophagus; single metastases in regional lymph nodes
  • III – a tumor that circularly affects the esophagus, germinating its entire wall, soldered

with neighboring organs; esophageal patency is significantly or completely impaired, multiple metastases in regional lymph nodes

• • IV – the tumor sprouts all the membranes of the esophageal wall, goes beyond the organ, penetrates into nearby organs; there are conglomerates of immobile regional metastatic lymph nodes and metastases to distant organs.

Clinical picture

t Symptoms characteristic of damage to the esophagus

• • Dysphagia (difficulty swallowing). Progressive dysphagia with solid food indicates esophageal obstruction. Persistent dysphagia when taking solid food occurs when the lumen of the esophagus narrows to 1.2 cm or less. Fluid dysphagia, cough, hoarseness, and cachexia are symptoms of advanced esophageal carcinoma
  • Increased salivation
  • Pain when swallowing. Pain means the tumor has spread beyond the wall of the esophagus
  • Smell from the mouth
  • Regurgitation (regurgitation, esophageal vomiting).
  • Symptoms characteristic of damage to the organs of the chest cavity: dull pain in the chest, shortness of breath, tachycardia after eating, change in voice timbre, coughing spells, swelling of the supraclavicular fossa.
  • General nonspecific symptoms: weakness, fatigue, apathy, weight loss, unreasonable subfebrile condition.

Diagnostics

• • X-ray contrast examination of the esophagus allows you to establish a diagnosis, determine the location and extent of the tumor
  • Esophagoscopy is the most important examination in the diagnosis of esophageal cancer. When performing esophagoscopy, the nature of tumor growth, its localization, extent, are determined, and a biopsy is performed.
  • Bronchoscopy is performed to assess the likelihood of tumor invasion into the tracheobronchial tree.
  • CT is performed to assess the local spread of the tumor through the lymphatic vessels, as well as to detect possible distant metastases.

Treatment

• • Surgical treatment is carried out with lesions of the lower third or distal part of the middle third of the esophagus. The advantage of surgery is the restoration of the lumen of the organ
  • Operational approaches: right-sided thoracotomy; laparotomy, diaphragmotomy, cervical mediastinotomy on the left
  • The operation is a resection or complete removal of the esophagus with reconstructive surgery
  • To restore the continuity of the gastrointestinal tract and plastics of the esophagus, either the stomach or the colon is used.
  • Radiation therapy and chemotherapy exist as an adjunct to surgical treatment.
  • Radiation therapy is indicated for localization of lesions in the proximal part of the middle third or in the upper third of the esophagus. The average dose is approximately 40-60 Gy 
  • Chemotherapy has practically no effect on the life expectancy of patients. More encouraging results have been obtained with combinations of chemotherapy and radiotherapy.
  • Chemotherapy and radiation therapy given before surgery reduces the size of the tumor and improves the long-term results of surgical treatment.
  • Palliatives
  • At high risk of surgery, radiation and chemotherapy are used to obtain temporary relief.
  • With advanced disease (tumor germination in the tracheobronchial tree or the presence of distant metastases), a palliative effect can be achieved by conducting a tube

a large-diameter suture through the site of obstruction of the esophagus by the tumor, thereby allowing the patient to swallow saliva and liquid food

• • With complete dysphagia, a gastrostomy is applied
  • Sometimes esophageal bougienage or dilators with silicone tubes are used to maintain the lumen.
  • Lasers are used to cauterize the tumor in order to restore the lumen of the organ.

Forecast. With surgical treatment, the 5-year survival rate for all groups of patients is 5-15%. In patients operated on in the early stages of the disease (without visible involvement of the lymph nodes), the 5-year survival rate increases to 30%. also Tumor, radiotherapy; Tumor, markers; Tumor,

methods of treatment; Tumor, stages

ICD. C15 Malignant neoplasm of esophagus