Cancer esophagus upper lower middle thirds

Cancer esophagus upper lower middle thirds

 Introduction

Cancer esophagus is cancer or malignant tumor which arise in the esophagus which its muscular tubular structure extended from the throat or pharynx above to the stomach or cardia of the stomach below and responsible for carrying the food and drinking through its length to reach the stomach

The esophagus can be divided into three parts upper third ,middle third and lower third each about 9 cm

also esophagus can be divided according to its location into three parts cervical part which present in the neck and it is about 5 cm and thoracic part which lies within the chest cavity and it is about 20 cm and abdominal part which lies within the abdominal cavity and it is about 2 cm

Incidence of esophageal carcinoma

Common in male more than female

Common in old age more than 60 years rare below age 40 years

Common in China Russia and South Africa

What are the site of cancer esophagus

Common site at the points of normal narrowing and at lower esophagus and gastroesophageal junction GOJ

What are the types of cancer esophagus

• Squmamous cell carcinoma is the most common types which can be arise at any level within the esophagus
• Adenocarcinoma which mainly arise in the lower third of the esophagus and at the gastroesophageal junction the major predisposing factor is Barrett,s esophagus which originated from the metaplastic Barrett,s mucosa and resembles gastric cancer
•   Oat cell carcinoma is rare type and associated with poor prognosis
• Other rare tumors are adenoid cystic carcinoma , melanoma and carcinoid tumors

What are the causes of cancer esophagus

  There are many risk factors which associated with development of cancer esophagus

 Which can be divided such as

Risk factors associated with squamous cell carcinoma

• Smoking and tobacco used
• High alcohol intake
• Nitorso compounds in pickled vegetables and smoked meats or nitrosamines in diet
• Minerals deficiencies such as zinc and molybdenum
• Vitamins deficiencies such as vitamins A and C
• Achalalesia and leukoplakia
• Congenital esophageal web or plummer -vinson syndrome which it is rare disease of females from iron deficiency characterized by dysphagia due to development of post-cricoid web with glossitis spoon shaped nails splenomegaly and anemia 
• Corrosive ingestion or swallowing strong alkaline such as lye or acids
• Coeliac disease
• Esophageal strictures and diverticula
• Peptic ulcer
• Tylosis and Howel-Evans syndrome which is hereditary or autosomal dominant disorders characterized by hyperkertosis or thickness of the skin of the palms of the hands and soles of the foots
•  Human papilloma virus and fugal infections of the esophagus
• Prolonged exposure to radiation therapy
• Partial complete removal of the stomach

Risk factors associated adenocarcinoma

•  Barrett,s esophagus
• Gastroesophageal reflux
• High fat intake
• Cigarette smoking
• High alcohol intake
• Zollinger - Ellison syndrome
• Hiatus hernia

What are symptoms and signs of cancer esophagus

• The patient may complaining from difficult in swallowing called dysphagia which may represented late in the disease because for dysphagia to occur it need at least 60% of esophageal circumference to involved or infiltrated by the cancer this type of malignant dysphagia has the following characters malignant dysphagia of short duration few months dysphagia to solid but not to the fluid in the start but later for both solids and fluid  the dysphagia is progressive in nature due to increased the tumor size it is accompanied by bad general condition of the patient due to it is associated with old age malnutrition toxeamia due to absorption of necrotic malignant tissue
• The patient may complaining from pain during swallowing called adenophagia
• The patient may complaining from loss of appetite poor nutrition and loss of weight
• The patient may complaining from  pain in the form of heart burn behind the sternum or at epigastric region the pain may severe and increased by eating may continuous most of the day
• The patient may complaining from cough and choking and aspiration pneumonia if the tumor extended to trachea and causes tracheoesophageal fistula 
• The patient may complaining from stridor if the tumor extended to the tracheobroncheal tree
• The patient may complaining from hoarseness of voice if the tumor extended to the recurrent laryngeal nerve causing its paralysis which lead to vocal cord paralysis
• The patient may complaining from systemic manifestations when the tumor spread or metastasis to other organs such as jaundice and ascites in case of liver metastasis and bone pain or pathological bone fractures in case of bone metastasis or shortness of breathing or dyspnea and pleural effusion in case of lung metastasis
•      The patient may complaining from non specific gasrtointestinal symptoms  so most of the esophageal cancers are discovered late  because the patient symptoms may unclear untill more than half of the esophageal lumen become obstructed by the cancer
• The cancer may discovered incidentally during endoscopic esophageal survey
• The patient may complaining from regurgitation and vomiting
• The patient may complaining from vomiting of blood  which may be massive called haematemesis
• The patient may complaining from hiccough due to extended of the cancer to phrenic nerve  may causes diaphragmatic paralysis
• The patient may complaining from swelling such as lymph nodes enlarged or lymphadenopathay 

What are the investigations of cancer esophagus

Barium swallow

Which may showing short esophageal segment narrowing, irregular filling defect, rat tail appearance in case of cancer lower third and mild proximal dilatation may appear

Upper endoscopy or esophagoscopy

Which showing the growth lesion and a biopsy has been taken for histological examination

Other investigations for cancer staging to detect cancer spread or metastasis to other organs such as

Plain X rays and  computerized  tomography CT scanning of the chest

Abdominal ultrasound and CT scanning

Thorascopy and laporascopy

 Magnetic resonance imaging MRI  scanning

Endoscopic ultrasound

Positron emission tomography

tags:esophagus,cancer,upper,middle,lower,squamous,tylosis