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Esophageal Cancers - Coggle Diagram
Esophageal Cancers
Treatment
if the tumor is localized without metastasis then surgical resection (esophagectomy) or endoscopic mucosal resection for early lesions is the best treatment to ensure long-lasting effects and prevents further destruction from the tumor.
Advanced cases: chemotherapy and radiotherapy can be combined for palliative care and to shrink the size of the tumor. Targeted therapy and immunotherapy may also be done.
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Pathophysiology
SCC: develops due to squamous dysplasia from long lasting irritation (eg: tobacco and alcohol). mostly occurs in the middle third of the esophagus. It metastasizes via lymphatic pathways
Adenocarcinoma: develops from intestinal metaplasia (Barrett esophagus) and GERD. it occurs in the distal esophagus and can extend to the gastric cardia. the tumor cells produce mucin and can form glands
Prognosis
SCC: 75% for superficial lesions, 20% for advanced disease in a 5-year span.
Adenocarcinoma: <25% for advanced disease but up to 80% for mucosa-confined tumors in a 5 year period.
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Definition
malignancies originating from the esophageal epithelium. there are two main types which are:
SCC: arises from squamous epithelial cells
Adenocarcinoma: arises from glandular cells typically due to Barett esophagus
Clinical Manifestations
common to both types: dysphagia, odynophagia, weight loss, hematemesis, chest pain and vomiting
SCC specific: symptoms of iron deficiency anemia due to chronic blood loss and strictures causing narrowing of the esophagus.
Adenocarcinoma-specific: Barrett esophagus is usually present alongside the tumor. it spreads to submucosal lymphatic vessels before onset of symptoms.
Investigations
endoscopy with biopsy: visualize tumors and obtain tissue sample in order to diagnose the type of tumor and to find out if it is malignant or not.
Barium swallow: identifies esophageal strictures in the esophageal lumen or any other irregularities.
CT/ PET scan: assesses the amount of invasion into other organs and metastasis via lymph nodes.
Endoscopic ultrasound: determines the depth of the tumor and lymph node involvement.
Physical Examination
no key physical findings in the early stages of both types of esophageal cancer.
signs of malnutrition weight loss or lymphadenopathy in advanced stages.