الفهرس 
Anatomy of the esophagusOnly 14 pages are availabe for public view
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Abstract
Esophageal cancer is a malignancy with a poor prognosis. It is the sixth cause of cancer-related death worldwide. The incidence of esophageal cancer has increased dramatically during the past 3 decades.
Nutritional deficiencies including low level of vit. A, C, riboflavin, mineral elements Such as selenium, zinc, molybdenum and high levels of nitrates, nitrites which are converted to N-nitrosamines, alcohol and tobacco use are predisposing conditions, also achalasia, caustic injuries, ptylosis, Plummer-Vinson syndrome, Barrett’s metaplasia, gastroesophageal reflux, obesity, H.pylori infection contribute to the pathogenesis of esophageal carcinoma.
History of irradiation has been linked to an increased risk of esophagel carcinoma. The first report that linked radiation therapy with cancer of the esophagus appeared in the early 1960s, when several case reports described cases of esophageal cancer after regional radiation treatment for primary cancers of the head, neck, and chest. More recently, several reports described case series observed in various hospitals around the world.
Dysphagia, usually for solids, is the most common presenting feature of esophageal carcinoma. It can progress to dysphagia for liquids and odynophagia. Weight loss inevitably follows and is an adverse prognostic factor. Regurgitation, retrosternal pain, and hoarseness might also occur. Direct invasion of the airway presenting as a tracheoesophageal fistula or invasion into the aorta with fulminant bleeding, although rare, can occur with local progression. Common sites of metastases include the liver, lung, bone, peritoneum, and nonregional lymph nodes. The brain is an uncommon site for spread.
Oesophageal carcinoma is considered one of the most challenging gastrointestinal malignancies. The recent modalities of investigations improve diagnosis and staging but because the early presenting symptoms of oesophageal carcinoma are nonspecific early diagnosis remain restricted. The surveillance endoscopy and patient who undergo upper GI endoscopy for reflux symptoms is the only tool for early diagnosis. Once diagnosis is confirmed by histopathological examination of specimen collected by endoscopic biopsies, recently evolved modalities of imaging (CT-PET, Endoscopic ultrasonography, and MRI) and improvement of imaging sensitivity provide revolution in preoperative staging and guide the treatment decision.
Management of esophageal carcinoma is based on tumor extent according to the TNM classification and is divided into curative and palliative treatment. The selection of curative versus palliative operation for oesophageal carcinoma is based on location of the tumor, the patient age and health, the extent of disease and intra operative staging. Patient with early disease generally do well with surgical resection provide curative procedure with macroscopic and microscopic clear margins. In patient with local-regional advanced disease multimodality treatment can now provide better results including pre and post operative chemo and radio therapy.
For patients with regional disease, resection and en bloc lymphadenectomy provides the best chance of cure and should be the treatment of choice. The primary rationale for an en bloc resection and extended lymphadenectomy is to minimize the incidence of local and regional recurrence and maximize the chances of long-term survival and cure.
Endoscopic mucosal resection, photodynamic therapy, radiofrequency ablation, and combinations of these have been studied in the setting of high-grade dysplasia and early invasive carcinoma. Options for esophageal resection in early stage cancer include transhiatal or transthoracic simple esophagectomy, vagal sparing, or minimal invasive esophagectomy.
A number of different techniques can be applied for patients with irresectable esophageal cancer to induce relief of dysphagia, such as external beam radiation therapy, intraluminal radiation therapy, dilation, insertion of a self-expanding metal stent, thermal laser treatment, photodynamic therapy or local injections of absolute alcohol into tumor nodules.
In order to provide the best quality of care to patients who have undergone curative resection, clinical follow up is recommended. This allows the clinician to detect and treat benign complications of their treatment, detect recurrent or metastatic disease, assess and manage nutritional disorders, provide psychosocial support to patients and their families and facilitate auditing of surgical outcomes.
Many units recommend an initial postoperative visit four to six weeks after surgery to check on wounds, nutritional status and record any early complications from treatment.