Oesophageal cancers
- In the
US , oesophageal carcinomas represent 6% of all cancers of the GIT but have a disproportionately high death rate - Malignant stromal tumours are rare
Squamous cell carcinoma
- The most common type of oesophageal carcinoma
- Generally occurs over the age of 50, in males more than females and in the blacks more than whites
- Areas where the incidence rate is particularly high are;
Iran - Central china
South Africa Southern Brazil
Aetiology and Pathogenesis
- Pathogenesis is multifactoral; environmental and diet contributing synergistically, modified by genetic factors
- Factors associated with the development of squamous cell carcinoma of the oesophagus;
- Dietary;
- Vitamin deficiency e.g. Vit A and C
- Deficiency of trace elements e.g. zinc
- Fungal contamination of food stuffs
- High contents of nitrites and nitrosamines
- Betel chewing
- Vitamin deficiency e.g. Vit A and C
- Lifestyle;
- Burning hot beverages or food
- Alcohol
- Tobacco
- Urban environment
- Burning hot beverages or food
- Oesophageal disorders
- Long standing oesophagitis
- Acalasia
- Plummer-Vinson syndrome
- Long standing oesophagitis
- Genetic predisposition
- Long standing Celiac disease
- Racial disposition
- Long standing Celiac disease
- Dietary;
Morphology
- 20% occur in the upper 1/3 of the oesophagus
- 50% occur in the middle 1/3
- 30% occur in the lower 1/3
- Squamous cell begins as in situ grey/white plaque like lesions
- Lesions subsequently extend longitudinally and circumferentially and invade deeply
- Tumours can spread via submucosal lymphatic networks to nearly lymph nodes and extend deeplyinto adjacent mediastinal structures
- Grossly lesions may be polypoid, exhibit necrotising excavation or be diffusely infiltrative
- Histologically tumours may be moderately to well differentiated with or without keratinisation
Clinical features
- Insidious onset, symptoms generally develop late and include;
- Dysphagia
- Obstruction
- Weight loss
- Haemorrhage
- Sepsis secondary to ulceration
- Respiratory tree fistulas with aspiration
- Dysphagia
- 80% are surgically resectable however the overall survival rate of all oesophageal cancers is 9%
Adenocarcinoma
- Malignant epithelial tumour with glandular differentiation
- Less common worldwide than squamous carcinoma but represents 50% of oesophageal cancers in the
US - Increased incidence in recent decades
- The majority of cases arise from Barrett mucosa
- Most are in the distal 1/3 of the oesophagus
Aetiology and Pathogenesis
- The lifetime risk of developing adenocarcinoma from Barrett oesophagus is 10%
- Tobacco and obesity are also risk factors but not alcohol
- Some evidence that H.pylori may be a contributing factors
- The genetic alteration from Barrett oesophagus to adenocarcinoma are; p53 overexpression, 17p allelic losses and loss of cell cycle control at the G1 to S phase transition
Morphology
- Grossly; findings range from nodules to excavated and deeply infiltrative masses
- Microscopically; typically mucin producing glandular tissues with intestinal features or diffusely infiltrative signet ring cells are seen.
Clinical
- More common in males, over the age of 40 and in whites instead of blacks
- Symptoms are the same as squamous cell carcinoma
- Previous symptoms of GORD are only present in 50% of patients
- 5 year survival is only 20%