（医学课件）食管癌医学课件.ppt

Esophagus cancer,1,2,3,Two most common forms of esophageal cancer are named for the type of cells that become malignant Squamous cell carcinoma forms in squamous cells, the thin, flat cells lining the esophagus. This cancer is most often found in the upper and middle part of the esophagus Adenocarcinoma begins in glandular (secretory) cells. Glandular cells in the lining of the esophagus produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the esophagus, near the stomach,4,.,In the 1960s squamous cancer accounted for more than 90% of cases but over the last two decades adenocarcinoma has dramatically increased and is now over 60% in the US. Tumors at the esophagogastric junction and proximal 5 cm of the stomach that extend into the EGJ or esophagus are classified and staged as esophageal cancers (the so-called Siewert III EGJ tumors). All other tumors with an epicenter in the stomach 5 cm from the EGJ, or those within 5 cm or the EGJ without extension into the esophagus are staged as gastric cancers.,5,.,Squamous Cancer Now only accounts for less than 30% of cases in the US. Tobacco and Alcohol are the major risk factors. Adenocarcinoma now most common type in the US, esp in white men Obesity and a high Body Mass Index (BMI) are high risk factors, very high BMI risk is 7.6 X higher GERD (gastroesophageal reflux) high risk Barretts esophagus increases the risk to 30 60 X higher,6,.,Tests that examine the esophagus are used to detect (find) and diagnose esophageal cancer,7,.,Signs and Symptoms of sophagus Cancer,Difficulty and pain with swallowing , Vomiting Dysphagia (most common); initially for solids, eventually progressing to include liquids (usually occurs when esophageal lumen 13 mm) ;Frequent choking on food Pressure or burning in the chest, Indigestion or heartburn, Epigastric or retrosternal pain. Pain behind the breastbone or in the throat Unexplained weight loss hoarseness or Intractable coughing or frequent pneumonia due to tracheobronchial fistulas caused by direct invasion of tumor through the esophageal wall and into the mainstem bronchus),8,.,Risk Factors, Tobacco use. Heavy alcohol use. Barrett esophagus Older age. Being male. Being African-American,9,.,Physical exam and history Chest x-ray Barium swallow Esophagoscopy Biopsy,10,.,11,.,12,.,The prognosis (chance of recovery) and treatment options depend on the following,The stage of the cancer (whether it affects part of the esophagus, involves the whole esophagus, or has spread to other places in the body). Whether the tumor can be completely removed by surgery. The patients general health.,13,.,After esophageal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the esophagus or to other parts of the body. The process used to find out if cancer cells have spread within the esophagus or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:,14,.,Endoscopic ultrasound (EUS) CT scan (CAT scan) such as the chest, abdomen, and pelvis, taken from different angles. PET scan (positron emission tomography scan) MRI (magnetic resonance imaging) Thoracoscopy Laparoscopy,15,.,16,.,17,.,18,.,19,.,The grade of the tumor is also used to describe the cancer and plan treatment,In grade 1, the cancer cells look more like normal cells under a microscope and grow and spread more slowly than grade 2 and 3 cancer cells. In grade 2, the cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 cancer cells. In grade 3, the cancer cells look more abnormal under a microscope and grow and spread more quickly than grade 1 and 2 cancer cells.,20,.,21,.,22,.,23,.,24,.,25,.,26,.,27,.,28,.,29,.,30,.,31,.,32,.,Treatment Option Overview,special nutritional Surgery Radiation therapy Chemotherapy Chemoradiation therapy Laser therapy Electrocoagulation New types of treatment are being tested in clinical trials. Targeted therapy,33,.,Stage I-III (locoregional disease) - Available modalities are endoscopic therapies (eg, mucosal resection or ablation), esophagectomy, preoperative chemoradiation, and definitive chemoradiation. Stage IV Systemic chemotherapy with palliative/supportive care for patients with ECOG performance score of 2 or less and palliative/supportive care only for patients with ECOG performance score of 3 or more.,34,.,Surgical options include the following:,Ivor Lewis esophagogastrectomy (laparotomy plus right thoracotomy) McKeown esophagogastrectomy (right thoracotomy plus laparotomy plus cervical anastomosis) Minimally invasive Ivor Lewis esophagogastrectomy (laparoscopic approach) Minimally invasive McKeown esophagogastrectomy (laparoscopic approach) Robotic minimally invasive esophagogastrectomy Transhiatal esop