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Esophageal Cancer

Sq cell carcinoma and adenocarcinoma account for more than 95 % of tumors. For most of the twentieth century, SCC comprised the vast majority of cancers. In the 1960s, SCC 90%. For the past two decades the two tumors now occur with almost equal prevalence
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Epidemiology of Esophageal Cancer in the United States


Squamous
New cases per year Male-to-female ratio Black-to-white ratio Most common locations Major risk factors 6000 3:1 6:1 middle smoking alcohol

Adeno
6000 7:1 1:4 distal Barrett s esophagus

Temple University/Conemaugh Memorial Hospital Esophageal CA VG/2000

Squamous Cell Carcinoma


The highest rates are found in Asia (particularly in China and Singapore), Africa, and Iran. Lower socioeconomic status was associated with esophageal SCC in a large population-based study.

Temple University/Conemaugh Memorial Hospital Esophageal CA VG/2000

Risk Factors
Smoking and alcohol Dietary factors *N-nitroso compounds (animal carcinogens)
*Pickled vegetables and other food-products *Toxin-producing fungi *Betel nut chewing *Ingestion of very hot foods and beverages (such as tea)

Underlying esophageal disease (such as


achalasia and caustic strictures)
Temple University/Conemaugh Memorial Hospital Esophageal CA VG/2000

Risk Factors
Human papilloma virus HPV
serotype 16 was identified in 9 percent of resection specimens from 70 Chinese patients with esophageal SCC.

Tylosis rare disease associated with


hyperkeratosis of the palms of the hands and soles of the feet and a high rate of esophageal SCC
Temple University/Conemaugh Memorial Hospital Esophageal CA VG/2000

Adenocarcinoma
AC is largely a disease of Caucasians and males Alcohol is probably not an important risk factor Obesity has been associated with AC but not SCC Smoking probably increases the risk of AC Temple University/Conemaugh
Memorial Hospital Esophageal CA VG/2000

Risk Factors
Increased esophageal acid exposure (such as Zollinger-Ellison syndrome) Helicobacter pylori infection Probable protective role from chronic infection.
Temple University/Conemaugh Memorial Hospital Esophageal CA VG/2000

DIAGNOSTIC TESTING
The diagnosis of esophageal cancer is usually established by endoscopy Early esophageal cancer may appear as a superficial plaque or

ulceration

Advanced lesions may appear as a

stricture an ulcerated mass or


circumferential mass or a large ulceration.
Temple University/Conemaugh Memorial Hospital Esophageal CA VG/2000

Early, superficial esophageal cancer on endoscopy. Courtesy of William Brugge, MD Temple University/Conemaugh
Memorial Hospital Esophageal CA VG/2000

Circumferential ulceration esophageal cancer seen on endoscopy. Courtesy of William Brugge, MD


Temple University/Conemaugh Memorial Hospital Esophageal CA VG/2000

Malignant stricture of esophagus The tumor mass is not readily evident because it is predominantly infiltrating the esophageal wall. Courtesy of William Brugge, MD. Temple University/Conemaugh
Memorial Hospital Esophageal CA VG/2000

Biopsy
Confirm the diagnosis in more than 90% In a series of 202 consecutive patients, 47 of whom had gastric or esophageal carcinoma, the percentage of correct diagnoses of esophageal carcinoma were as follows First biopsy 93 percent Four biopsies 95 percent Seven biopsies 98 percent
Temple University/Conemaugh Memorial Hospital Esophageal CA VG/2000

Bx...
The addition of brush cytology specimens to seven biopsies increased the accuracy to 100%. Seventeen percent of lesions thought to be benign endoscopically were subsequently proven to be malignant.
Temple University/Conemaugh Memorial Hospital Esophageal CA VG/2000

Take home message


Surgical repair for symptoms of GERD did not prevent development of AC on top of Barrette s esophageous in this pt. Periodic endoscopy in Barrette s is needed No single modality is known to reverse the mucosal dysplasia in Barrette s as of yet. (Argon LASER Rx still under trial)
Temple University/Conemaugh Memorial Hospital Esophageal CA VG/2000