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Path: Oesophagus (ii) Oesophageal tumours (Malignant (prognosis (5 yr…
Path: Oesophagus (ii) Oesophageal tumours
Benign
uncommon
leiomyoma
lipoma
fibroma
Malignant
primary
epithelial
most are this type
SCC
squamous, mostly in upper/mid oeso
70%
risk factors
smoking + alcohol (direct exposure of these to mucos)
vit or trace mineral deficiences
high content of nitrites/nitrosamines
longstanding oesophagitis (increased cell turnover)
achalasia
Plummer-Vinson syndrome (rare disease characterised by dysphagia, iron-deficient anaemia, glossitis, cheilosis, webs) - rare with good nutrition
genetic predisposition
long standing coeliac disease
skin conditions
ectodermal dysplasia
epidermolysis bullosa (blistering)
adenocarc
glandular, mostly in lower 1/3 oeso
25%
85-90% of cases arise from Barrett's
GIST
secondary
mets rare
moreso nodal involvement (e.g. from lung)
prognosis
depends on stage + tumour type
often poor as presents late (large obstruction required to produce symptoms)
5 yr survival rates...
local disease: 45%
nodal disease: 25%
distant disease: 5%
spread locally, to nodes + via blood
Tx
neoadjuvant chemo radiotherapy
oesophageal resection (up to 40% can be removed)
not all patients suitable, esp those with mets
palliation: stents
Intro
presentation = dysphagia esp for solids
Dx: barium swallow, endoscopy, biopsy
gross appearance: polyploid, ulcerative, infiltrative