Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

28 Cards in this Set

  • Front
  • Back
Esophageal CA types
-Squamous Cell Carcinoma
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
-grows into lumen
-grow into wall then spreads laterally
-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)
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)
-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
5.granular cell tumors
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