扬州大学：《外科学》课程教学课件（PPT讲稿，Surgery）Chapter 20. Esophagus Diseases_Caircinoma of the Esophagus

Carcinoma of the EsophagusSquamouscellcancerAdenocarcinoma

Carcinoma of the Esophagus

EssentialsofDiagnosis: Progressive dysphagia, initially during ingestion of solidfoods and later for liquids.Progressive weight loss and inanition.Classic radiographic outlines: irregular mucosal patternwith narrowing, with shelf-like upper border orconcentrically narrowed esophageal lumen.. Definitive diagnosis established by endoscopic biopsy orcytology

Essentials of Diagnosis • Progressive dysphagia, initially during ingestion of solid foods and later for liquids. • Progressive weight loss and inanition. • Classic radiographic outlines: irregular mucosal pattern with narrowing, with shelf-like upper border or concentrically narrowed esophageal lumen. • Definitive diagnosis established by endoscopic biopsy or cytology

General Considerations. Carcinoma of the esophagus constituted about 1% of allmalignant lesions and 6% of those of the gastrointestinaltract in the USA.Blacks have a fivefold higher incidence of squamous cellcarcinoma than whites, but the incidence ofadenocarcinoma among blacks is one-third that of whitesBoth lesions are more common among men, with amale-to-female ratio of 7:10 for adenocarcinoma and 3:4forsquamous celltumors.: The peak incidence is between ages 50 and 60 years

General Considerations • Carcinoma of the esophagus constituted about 1% of all malignant lesions and 6% of those of the gastrointestinal tract in the USA. • Blacks have a fivefold higher incidence of squamous cell carcinoma than whites, but the incidence of adenocarcinoma among blacks is one-third that of whites. • Both lesions are more common among men, with a male-to-female ratio of 7:10 for adenocarcinoma and 3:4 for squamous cell tumors. • The peak incidence is between ages 50 and 60 years

: Estimated new cases and deaths fromesophageal cancer in the United States in2009:New cases: 16,470Deaths: 14,530Esophagealcancer- ww.cancer.gov

• Estimated new cases and deaths from esophageal cancer in the United States in 2009: New cases: 16,470 Deaths: 14,530 - www.cancer.gov

Causes;Not ExactlyKnownmoteneictobacco and alcohol use [3o*more likely)exposuretolyedietis notprovento have affect buta wellbalanced oneisalways encouraged

Causes and risk factorsStudieshavefoundthefollowingriskfactorsforesophageal cancer:Age65orolder:Ageisthemainriskfactorforesophageal cancer.Thechance of getting this disease goes up as you get older. In the UnitedStates, most people are 65 years of age or older when they are diagnosedwithesophagealcancer.Being male: In the United States, men are more than three times as likelyaswomentodevelopesophagealcancer.Smoking:People who smoke aremore likelythan peoplewhodon't smoketodevelopesophageal cancer.Heavy drinking: People who have more than 3 alcoholic drinks each dayare more likely than people who don't drink to develop squamous cellcarcinomaoftheesophagus.Heavydrinkerswho smokeareatamuchhigherriskthanheaydrinkerswhodon'tsmoke.Inotherwords,thesetwofactors acttogetherto increasetherisk evenmore

Causes and risk factors Studies have found the following risk factors for esophageal cancer: • Age 65 or older: Age is the main risk factor for esophageal cancer. The chance of getting this disease goes up as you get older. In the United States, most people are 65 years of age or older when they are diagnosed with esophageal cancer. • Being male: In the United States, men are more than three times as likely as women to develop esophageal cancer. • Smoking: People who smoke are more likely than people who don't smoke to develop esophageal cancer. • Heavy drinking: People who have more than 3 alcoholic drinks each day are more likely than people who don't drink to develop squamous cell carcinoma of the esophagus. Heavy drinkers who smoke are at a much higher risk than heavy drinkers who don't smoke. In other words, these two factors act together to increase the risk even more

Causes and risk factorsDiet:Studies suggest that having adietthat's lowinfruits and vegetables mayincreasetheriskofesophagealcancer.However,resultsfromdietstudiesdon'talwaysagree,andmore researchisneededtobetterunderstand howdietaffectstheriskofdeveloping esophagealcancer.Obesity:Being obese increases the risk ofadenocarcinoma oftheesophagusAcidreflux:Acidrefluxistheabnormal backwardflowofstomachacidintotheesophagus.Refluxisverycommon.Asymptomofrefluxisheartburn,butsomepeopledon'thavesymptoms.The stomachacidcandamagethetissueoftheesophagus.Aftermany years of reflux, this tissue damage may lead toadenocarcinomaoftheesophagusinsomepeople.Barrettesophaaus:Acidrefluxmaydamage the esophagusandovertime causeaconditionknownasBarrettesophagus.Thecellsinthelowerpartoftheesophagusareabnormal.Mostpeople whohaveBarrettesophagus don'tknowit.Thepresenceof Barrett esophagus increasesthe risk of adenocarcinoma ofthe esophagus.It's agreaterriskfactorthanacidrefluxalone

Causes and risk factors • Diet: Studies suggest that having a diet that's low in fruits and vegetables may increase the risk of esophageal cancer. However, results from diet studies don't always agree, and more research is needed to better understand how diet affects the risk of developing esophageal cancer. • Obesity: Being obese increases the risk of adenocarcinoma of the esophagus. • Acid reflux: Acid reflux is the abnormal backward flow of stomach acid into the esophagus. Reflux is very common. A symptom of reflux is heartburn, but some people don't have symptoms. The stomach acid can damage the tissue of the esophagus. After many years of reflux, this tissue damage may lead to adenocarcinoma of the esophagus in some people. • Barrett esophagus: Acid reflux may damage the esophagus and over time cause a condition known as Barrett esophagus. The cells in the lower part of the esophagus are abnormal. Most people who have Barrett esophagus don't know it. The presence of Barrett esophagus increases the risk of adenocarcinoma of the esophagus. It's a greater risk factor than acid reflux alone

Heavy alcohol or tobacco use is thought to predispose toesophageal carcinoma in the USA.: Adenocarcinoma of the esophagus, primarily related toBarrett's epithelium, has been increasing in frequency in theUSA and accounts for up to 4o% of cases in some seriesTwenty percent of esophageal tumors occur in the upperthird, 30% in the middle third, and 50% in the loweresophagus.. Squamous cell lesions predominate in the mid esophagus: Adenocarcinomas are more common in the lower third

• Heavy alcohol or tobacco use is thought to predispose to esophageal carcinoma in the USA. • Adenocarcinoma of the esophagus, primarily related to Barrett's epithelium, has been increasing in frequency in the USA and accounts for up to 40% of cases in some series. • Twenty percent of esophageal tumors occur in the upper third, 30% in the middle third, and 50% in the lower esophagus. • Squamous cell lesions predominate in the mid esophagus. • Adenocarcinomas are more common in the lower third

SquamouscellcancerAdenocarcinoma

MacroscopicFeatures Fungating-type: Predominantly intraluminal growth with surfaceulceration and extreme friability.This type frequentlyinvades mediastinalstructures.It is present in 11 to60% of cases.Ulcerating-type: Characterized by a flat based ulcer with slightly raisededges; hemorragic and friable and surroundinginduration and erythema.This ispresentin25to63%of patients.Infiltrating-type: A dense firm logitudinal and circumferentialintramuralgrowth pattern. The infiltrating type is found in 15 to 26% of squamous cellcarcinomatumors.Annular: Annular carcinomas may be mistaken for benign strictures,especiallyif most of the growth is intramural

❑ Fungating-type: Predominantly intraluminal growth with surface ulceration and extreme friability. This type frequently invades mediastinal structures. It is present in 11 to 60% of cases. ❑Ulcerating-type: Characterized by a flat based ulcer with slightly raised edges; hemorragic and friable and surrounding induration and erythema. This is present in 25 to 63% of patients. ❑Infiltrating-type: A dense firm logitudinal and circumferential intramural growth pattern. The infiltrating type is found in 15 to 26% of squamous cell carcinoma tumors. ❑Annular: Annular carcinomas may be mistaken for benign strictures, especially if most of the growth is intramural Macroscopic Features