食管癌本科-英语-精品医学课件

1、Esophageal cancer Objects and requisitions Master the clinical manifestations of esophageal cancerFamiliar with the diagnosis, anatomical characteristics, segmentation criteria of esophageal cancer and each period of esophageal cancer treatment principle and operation methodUnderstanding of the appl

2、ication of comprehensive treatment Emphasis and difficulty Clinical manifestations and differential diagnosis of esophageal cancerEsophageal pathology and the imaging performance of esophageal cancer Content Definition Epidemiology Classification Signs and symptoms Diagnosis and differential diagnos

3、is Treatment Definition Esophageal cancer begins in the cells of the inside lining. It then grows into the channel of the esophagus andthe esophageal wall. Esophageal cancer is malignancy of the esophagus. EpidemiologyMorbidity（LinXian Henan）：478.87/10 Causes and risk factorsAge: over 60 years oldSe

4、x: more common in menBad eating habitesHeredity: more likely in people who have close relatives with cancerTobacco smoking and heavy alcohol using Gastroesophageal reflux disease (GERD) and its resultant Barretts esophagusCauses and risk factorsParticular dietary substances, such as nitrosamineRadia

5、tion therapy for other conditions in the mediastinumOthers: Celiac disease, obesity, Plummer-Vinson syndromeDissectionThe esophagus startsfrom the cricoid cartilageand ends to the cardiac regionLength: 2530cm (adult)DissectionCervical Esophageal: 15-20cm away from the incisorsUpper-Thoracic Esophage

6、al： 20 -25cm away from the incisorsMiddle-Thoracic Esophageal： 25-30 cm away from the incisorsLower-Thoracic Esophageal： 30-40cm away from the incisors IncidenceThe incidence of esophageal cancer ranked fifth in all cancer sites in China.Males are more than females.More likely occurred in middle and

7、 lower thoracic esophagus . IncidenceClassification Squamous cells line theinner esophagus.Cancer developing from squamous cells can occur along the entire esophagus. Squamous cells that normally linethe esophagus are replaced by gland cells. Cancer developing from gland cells typically occurs in th

8、e lower esophagus near the stomach and is believed to be largely related to acid exposure to the lower esophagus.squamous cell carcinomaadenocarcinomaClassificationMedullary type：Classification Narrow typeClassification Mushroom umbrella typeClassificationUlcer typeSigns and symptomsEarly on there m

9、ay be no symptoms. In more advanced cancers, symptoms of esophageal cancerinclude: Dysphagia (most common)solids then liquid Odynophagia/retrosternal discomfort Anorexia (inappetence for food ) Weight loss （malnutrition） Regurgitation (nausea and vomiting)Hoarseness/voice change (lesion of recurrent

10、 laryngeal nerves) Aspiration/cough/recurrent pneumonia HematemesisDiagnosis If you have symptoms that may signal esophageal cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family medical history. One or mo

11、re of the following tests may be used to find out if you have esophageal cancer and if it has spread. These tests also may be used to find out if treatment is working. Imaging tests, which may include: Diagnosis Chest X-rayBarium swallow CT scanEndoscope : Esophagoscopy and Bronchoscopy Esophageal e

12、ndoscope ultrasound (EUS)Positron emission tomography (PET)BiopsyChest X-ray 1.Pneumonitis , Pleural effusion , Lung absces 2.A column of air in the esophagus 3.An air-fluid level Barium swallow Barium swallow This image demonstrates narrowing of the esophageal lumen at the site of the lesion and di

13、lation proximally. The tumor appears as an irregular mass. The lumen of the esophagus is almost obstruent.CT scanCT scan FDG-PETIt may find the early esophageal cancer .It may find the metastasisof lymph nodes or other organs .FDG-PETLiver metastasis: could cause jaundice and ascites Esophagoscopy E

14、ndoscopic image of patient with esophageal adenocarcinoma seen at gastro-esophageal junction EUSDifferential diagnosis Early esophageal cancer：Inflammation of the esophagusDiverticulum of the esophagusVaricosity of the esophagusDifferential diagnosis Advanced esophageal cancer：Achalasia of cardiaBen

15、ign stricture of esophagusBenign tumor of esophagusDifferential diagnosis Achalasia of cardiaDifferential diagnosis Benign stricture of esophagusHas a history of chemical burnDifferential diagnosis Benign tumor of esophagusEspecially esophageal leiomyoma Esophageal Cancer Staging source: National Ca

16、ncer Institute. The most common system used tostage esophageal cancer is the TNM system of the American Joint Committee on Cancer (AJCC). The TNM system describes three key pieces of information: Esophageal Cancer Staging T refers to the size of the primary tumor and how far it has spread within the

17、 esophagus and to nearby organs .N refers to cancer spread to nearby lymph nodes .M indicates whether the esophageal cancer has metastasized (spread to distant organs). Primary tumor (T)TXPrimary tumor cannot be assessedT0No evidence of primary tumorTisHigh-grade dysplasiaT1Tumor invades lamina prop

18、ria, muscularis mucosae, or submucosaT1aTumor invades lamina propria or muscularis mucosaeT1bTumor invades submucosaT2Tumor invades muscularis propriaT3Tumor invades adventitiaT4Tumor invades adjacent structuresT4aResectable tumor invading pleura, pericardium, or diaphragmT4bUnresectable tumor invad

19、ing other adjacent structures, such as the aorta, vertebral body, and tracheaRegional lymph nodes (N)NXRegional lymph node(s) cannot be assessedN0No regional lymph node metastasisN1Metastasis in 1-2 regional lymph nodesN2Metastasis in 3-6 regional lymph nodesN3Metastasis in 7 or more regional lymph

20、nodesDistant metastasis (M)M0No distant metastasisM1Distant metastasis GradeGXGrade cannot be assessedstage grouping as G1G1Well differentiatedG2Moderately differentiatedG3Poorly differentiatedG4Undifferentiatedstage grouping as G3 squamousTNM（Squamous cell carcinomas）StageT N M Grade Tumor location

21、0Tis (HGD) N0 M0 1, X AnyIAT1 N0 M0 1, X AnyIBT1 N0 M0 2-3 Any T2-3 N0 M0 1, X Lower, XIIAT2-3 N0 M0 1, X Upper, middle T2-3 N0 M0 2-3 Lower, XIIBT2-3 N0 M0 2-3 Upper, middle T1-2 N1 M0 Any AnyIIIAT1-2 N2 M0 Any Any T3 N1 M0 Any Any T4a N0 M0 Any AnyIIIBT3 N2 M0 Any AnyIIICT4a N1-2 M0 Any Any T4b An

22、y M0 Any Any Any N3 M0 Any AnyIVAny Any M1 Any AnyTNM（Adenocarcinomas）Stage T N M Grade0 Tis (HGD) N0 M0 1, XIA T1 N0 M0 1-2, XIB T1 N0 M0 3 T2 N0 M0 1-2, XIIA T2 N0 M0 3IIB T3 N0 M0 Any T1-2 N1 M0 AnyIIIA T1-2 N2 M0 Any T3 N1 M0 Any T4a N0 M0 AnyIIIB T3 N2 M0 AnyIIIC T4a N1-2 M0 Any T4b Any M0 Any

23、Any N3 M0 AnyIV Any Any M1 Any Treatments The treatment is determined by the cellular type of cancer (adenocarcinoma or squamous cell carcinoma vs other types), the stage of the disease, the general condition of the patient and other diseases present. On the whole, adequate nutrition needs to be ass

24、ured, and adequate dental care is vital. TreatmentsSurgery esophagectomyChemotherapyRadiotherapyOthersTreatments-Surgery This is the most common treatment for esophageal cancer that has not spread to the lymph nodes. The procedure most often performed is an esophagectomy, and there are several metho

25、ds to perform it. The surgery includes removal of:All or part of the esophagus Part of the stomach Lymph nodes that are close to the esophagusThe remaining stomach is pulled up into the chest or neck and connected to the remaining esophagus. You may need a feeding tube (a small tube that is inserted

26、 into the nose or mouth and into the stomach) until you are able to eat.Treatments-SurgerySide effects of the surgery may include:Leaking at the site where the stomach and esophagus are joined. This may mean the stomach empties slowly, causing nausea and vomiting. Trouble swallowing: An upper endosc

27、opy to stretch passages may help Heartburn Digestive problems: You may be able to eat only small amounts of food at a timeTo treat more-advanced stages of esophageal cancer, surgery may be combined with chemotherapy and/or radiation therapy.Selection of operationSweetindication: Middle/Lower-Thoraci

28、c Esophageal, the cope of cleaing is limited, narrow pplicable scope, imainly used for patients with cardia cancer or poor cardiopulmonary functionIvor Lewisindication: Middle/Lower-Thoracic Esophageal, EL(-)Ivor Lewis-Mckeownindication: Upper/Middle/Lower-Thoracic Esophageal, Wide range of applicat

29、ionCervical Esophageal treated with radiation and chemotherapy as the main means of comprehensive treatmentRadiation TherapyNew radiation therapy techniques and remarkable skill allow MD Anderson doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy