.Classification of esophageal cancer

Eye to the patient who tells you to have:

retrosternal pain that radiates to the shoulders, simulating angina pectoris;

burning region in substernal

Alalia sensation of difficulty swallowing, like a ball stops

odynophagia, that if I swallow pain

regurgitation of food, acid feeling in the mouth, especially when I lie down, dry, hacking cough at night, because I have unconsciously regurgitation during sleep and material migrates into the airways.

In fact the patient has pain and does not swallow (see also dysphagia) may have an injury of the esophagus heteroplastic nature, ie a tumor, but also a simple motor impairment, or at best a reflux esophagitis or ulceration or a Barrett, but in this case, is similar to precancerous lesions, that is half or cancer, however, a lesion to be treated and followed over time because you can associate with esophageal cancer.

To further compare these topics:

Acid regurgitation

Barrett's esophagus; strange chest pain

Investigations sull'esofago: manometry, which means?

The palliation of esophageal cancer: implants



CLASSIFICATION OF esophageal cancer


Good


Epithelial

Adenoma

Squamous papilloma

Non-epithelial

Leiomyoma

Neurogenic tumors

Granulosa cell tumors (mioblastomi)

Lipoma

angioma



malignant


Squamous cell carcinoma

Adenocarcinoma

Adenosquamous carcinoma

Mucoepidermoid carcinoma

Carcinoma adenoidocistico

Small cell undifferentiated carcinoma (oat cell type)

Leiomyosarcoma

Malignant schwannoma

Liposarcoma

KS



Among the benign tumors most frequently mention the leiomyoma which represents only 70% of benign tumors and is localized to the lower third of the esophagus, being composed of smooth muscle cells from muscularis mucosae. The endoscopic appearance is that of a rilevatezza wall of the esophagus that allows the passage of the endoscope. El'angioma papilloma lesions are reflected completely random and if the latter can have multiple angiomatosis.

But we come to malignant tumors. In fact before thinking of benign lesions, once excluding all other noxae causing dysphagia, having made an esophagogastroduodenoscopy or at least a "barium esophagus, ie a survey of the esophagus with radiographic contrast medium, should make diagnosis suffered a lesion, as if he spends precious time, it will be impossible to implement a radical trattmento the lesion or can implement only a palliation of any tumor (see The palliation of esophageal cancer: the prosthesis). The most frequent malignancies of the esophagus, said, el'adenocarcinoma are squamous cell carcinoma, which constitute 60-70% and 20-30%, respectively, squamous cell carcinoma may present different degrees of differentiation and sometimes may occur as early squamous cell carcinoma with initial development limited to the mucosa and submucosa. Adenocarcinoma is the cancer most associated with Barrett's esophagus, this strange injury last stretch of the esophagus, recognizable orange looking evaginate mucosal metaplasia in the esophagus to acid insult continued over time, for example in terms of gastroesophageal reflux.

So certainly be investigated carefully the patient turns to the doctor and says he has a burning epigastric and retrosternal.



Endoscopic classification of esophageal cancer

Early

The superficial and protruding type

Type II shallow dish: high

Superficial flat type IIb: flat
IIc type superficial plate: depressed

Superficial depressed type III



Advanced protruding type

Type ulcers
Type ulcerated infiltrating

Diffuse infiltrating type


The survey EUS is of considerable help in the preoperative staging of esophageal cancers, as it allows an accurate assessment of the degree of infiltration of the esophageal wall and adjacent structures, with 89% accuracy in particular allows the study of lymph pariesofagei

Old TNM staging system of cancer always useful

T1
Tumor limited to the mucosa and submucosa

T2
Tumor invades the muscularis

T3
Cancer that affects the tunica adventitia

T4
Tumor invades adjacent structures (trachea, connective tissue and fat, aorta and heart)

No
Node-negative, not interested

N1
Regional lymph nodes involved

M0
No metastases

M1
Distant metastasis

M1 liymph
Cancer with involvement of distant lymph nodes:

celiac lymph nodes

perigastric lymph nodes

supraclavicular and cervical lymph nodes



In those circumstances, say once that staging is the basis for decisions to be taken to intervene and treat the patient with esophageal cancer. Indeed the factors that are considered are:

And 'infiltrated the wall of the esophagus and nearby structures are taken, that the tumor has encroached into the mediastinum?

The lymph nodes are involved in the process, then the cancer has spread?

There are distant metastases, ie tumor cells are carried to other organs with the current blood, lymph and / or contiguity?

Findings prognosis.

At this point the doctor outlining the first sum and a prognostic assessment, regarding the 5-year survival of the patient, based on the following criteria:

If the submucosa is invaded but not other tissues, then the 5-year survival is 46% of patients, unless complications.

If the muscle layer was invaded and, therefore, the tumor has encroached, the 5-year survival drops to 30%;

If the adventitia is taken, then drops 22%

If infiltrated neighboring organs, 7%

If there are distant metastases is reduced to 3% more.

This writer had to follow patients with esophageal cancer, implementing palliative maneuvers to enable them to feed. (Cf. see the palliation of esophageal cancer: the prosthesis). In fact, the physician must discern whether the surgical risks outweigh the benefits it is intended for the patient. In other words, one must ask, knowledge and belief, what is the right way to act, that is whether the surgery and follow-up treatment can ensure a long life or not, given that it is already an excellent result survive for 5 years.

In the opinion endoscopist, radiologist, oncologist and endoscopic injury is liable to action then can think of making a resection of esophageal cancer that leads to a non-simple reconstruction of the street food in general is obtained by tracing the intestinal loop of fasting in the mediastinum, pharynx bite. Other times, it is preferable to simply use the laser to palliate lesions or implants that allow recanalize or, at worst, you can feed the patient by enteral or parenteral nutrition.

In recent years, chemotherapy has been providing increasingly good results, although it remains a palliative therapy or used to support the next surgery.


 

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