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28 Cards in this Set

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Esophageal CA types
-Squamous Cell Carcinoma
-Adenocarcinoma
Adeno>SCCA (but roughly 50/50)
-both: avg. age of onset=70
Esophageal SCCA
Squamous Cell Carcinoma:
-from squamous epithelium.
-Composed of solid nests/cords of squamous cells +/- keratin pearls
Esophageal Adeno CA
Composed of glands
Arises from either:
a.normal simple columnar glandular epithelium
b.exocrine glands-mucus glands
c.metaplastic glandular epithelium
Esophageal Cancer presentation
Almost always: dysphagia
Sometimes: weight loss(bad)->mets disease
Less common:
Chest pain
GI bleeding
Shortness of breath
Occasionally: with distant metastatic disease
gross morphology type for malignancies
Fungating=Polypoid=Exophytic:
-grows into lumen
Infiltrating:
-grow into wall then spreads laterally
Ulcerating:
-grow deeply into wall w/ necrosis
Basic esophageal cancer epidemiology
-uncommon in US
-Avg. age of onset=70
SCCA Epidemiology
More common in African-Americans
More common in lower SES(poor)
smoking
EtOH
toxic ingestions
Esophageal Adenocarcinoma Epidemiology
More common in Caucasians(like berretts)
Strongly associated with reflux symptoms(GERD) and the development of Barrett’s esophagus
Esophageal cancer DDx
-Esophageal strictures
-Extrinsic compression of the esophagus (other cancers, aneurysms, etc)
-Viral infection of the esophagus
-Benign esophageal growths
-Erosive esophagitis
Esophageal Adenocarcinoma Basics
-almost all from Barrett's epith
-few from esoph mucus glands
Esophageal Adenocarcinoma Natural history
10% of patients with Barrett metaplasia → adenocarcinoma
Risk related to:
-length of the metaplastic segment
-presence and degree of dysplasia
Esophageal Adenocarcinoma Pathogenisis
Continued reflux of gastric contents
->Continued injury of metaplastic epithelium
->↑ mitosis as epithelium regenerates
->↑opportunities for genetic alterations
->Dysplastic changes
-can → AdenoCA
Esophageal dysplasia Histopathology
Dysplasia-typified by nuclear changes:
-large(↑N/C ratio
-pleomorphic(diff shape/size)
-hyperchromatic
-prominent nucleoli
at multiple levels in the cell(normally all basal)
-↑mitotic figures
Esophageal Adenocarcinoma Gross Pathology
-in distal esophagus(site of Barretts)
-any pattern:(fungating, ulcerating, infiltrating)
Esophageal Adenocarcinoma Histopathology
Invasive atypical glands
Esophageal SCCA causes/RF's
Dietary factors (ETOH, others)
Environmental factors(tobacco use, others)
Esophageal diseases (chronic esophagitis, others)
Genetics (blacks > other races)
Esophageal SCCA Gross
Any where in esophagus
Any pattern(fungating, ulcerating, infiltrating)
Esophageal SCCA Histopathology
Nests/cords of atypical squamous epithelial cells in desmoplastic (fibrotic) stroma
-secrete growth factors(cause fibrosis)
Growth of Esophageal malignancies
1.Circumferential growth can lead to stenosis and obstruction of lumen → dysphagia
2.Invasion into neighboring structures is common.
Esophageal cancer testing
-Diagnosis almost always made by endoscopy(need biopsy to say what type)
-May be preceded by barium esophagram
-CT scan, MRI and EUS(ultrasound on endoscope)->extent of the tumor
Esophageal cancer Therapy
Resection = best hope for cure
-Tough surgery(back of chest)
-30-40% morbidity, 2-5% mortality
Rads/Chemo usually palliative, occasionally curative
May use rads/chemo pre-op to shrink tumor
Can use lasers endoscopically to cut away tumor for palliation
Can place stents inside esophagus to open it
Esophageal Cancer Outcomes
Most cancers present at a stage too advanced for a cure
Overall, survival is dismal:
-1 year survival = 18%
-5 year survival = 5%
Even those considered “resectable” have 5 yr survival <50%
Benign Esophageal Tumors
1.leiomyomas(from smooth muscle=leiomyoma, don't do anything)
2.esophageal cysts
3.fibrovascular polyps
4.papillomas
5.granular cell tumors
6.Lipomas
Most occur submucosally
Endoscopic ultrasound helps determine histology
Shotzky’s Ring
stricture at the junction b/w esophagus and stomach
Complications of esophageal malignancy
Nodal Mets
Local infiltration
visceral mets
Esophageal malignancy Nodal mets
Upper 1/3 → cervical & supraclavicular nodes
Mid 1/3 → hilar & tracheal nodes
Lower 1/3 → gastric & celiac nodes
Esophageal malignancy Local infiltration
No serosa(around esoph) → infiltrates neighboring structures:
-Recurrent laryngeal n. → hoarseness
-Trachea → cough
-Aorta → hemorrhage
Esophageal malignancy Visceral mets
-Skin
-Liver
-Lungs
-etc.