الفهرس 
Introduction &Aim of the workOnly 14 pages are availabe for public view
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Abstract
Malignant dysphagia means difficullty in swallowing due to irreversible malignant
strictures e.g :- primary oseophageal cancer , oseaphago gastric junction tumor .(1)
Aim of the work:-
Evaluation of oesophageal malignant dysphagia as regard the clinical presentation, methods of
diagnosis , pathology of tumor and different measures of management .
Anatomy of oseophagus:-
The oesophagus is a muscular tube protected at its ends by the upper and lower oesophageal
sphincters. It commences as a continuation of the pharynx at the lower border of the cricopharyngeus muscle, at the level of the sixth cervical vertebra (C6). The surface marking for
this point is the lower border of the cricoid cartilage. It enters the chest at the level of the
suprasternal notch and descends through the superior and posterior mediastinum along the
front of the vertebral column. It passes though the oesophageal hiatus in the diaphragm at the
level of the 10th thoracic vertebra to end at the gastro-oesophageal junction. The surface
marking for this point is the left seventh costal cartilage. The oesophagus measures 25–30 cm
in length although this varies according to the height of the individual and in particular the
suprasternal–xiphoid distance(3).
Pathogenesis of Cancer oseophagus:-
The two most common histological types of esophageal carcinoma include SCC and
adenocarcinoma. Less than 1% to 2% of all esophageal cancers are sarcomas or small cell
carcinomas. Rarely lymphomas, carcinoids and melanomas may arise in the esophagus(19).
ROUTES OF ESOPHAGEAL CANCER SPREAD:-
Prognosis in esophageal cancer is greatly dependent on local invasion as well as spread to
regional and distant structures within the body. Esophageal cancer is aggressive in nature,
spreading by a variety of pathways including direct extension, lymphatic spread and
hematogenous metastasis. The lack of serosa in the esophageal wall plays an integral role in
the local extension of esophageal cancer. With no anatomical barrier, the primary tumor is
able to extend rapidly into the adjacent structures of the neck and thorax including the thyroid
gland, trachea, larynx, lung, pericardium, aorta and diaphragm(34). The lymphatic drainage of
the esophagus is extensive. It is drained by two separate lymphatic plexuses, with one
lymphatic plexus arising within the mucosal layer and a second plexus arising within the
muscular layer. A majority of the lymphatic fluid from the upper two-thirds of the esophagus
tends to flow upward, and the lymph from the lower third of the esophagus flows relatively
downward, but all the lymphatic channels of the esophagus communicate. Therefore,
lymphatic fluid from any portion of the esophagus may spread in either direction and spread
to the intra-thoracic or intra-abdominal lymph nodes (35). Esophageal cancer also spreads
hematogenously, in order of decreasing frequency, to the liver, lungs, bones, adrenal glands,
kidney and brain. This method of spread is more common with more advanced stages of
esophageal cancer (36).
Staging of Cancer Oseophagus :-
TNM system, specifically referring to depth of invasion in T staging(37)
Category Description
Tis Carcinoma in situ.
T1 Tumors invade lamina propria or submucosa.
T2 Tumors invade muscularis propria.
T3 Tumors invade adventitia.
T4 Tumors invade adjacent structures.
N0 No regional lymph node metastasis.
N1 Regional lymph node metastasis.
M0 No distant metastasis.
M1a, M1b Distant metastasis.
Stage-specific protocols for treatment :-
Stage Tumor Node Metastasis Operative options
0 Tis N0 M0 Local ablative therapy
I T1 N0 M0 Surgery
II A T2
T3
N0
N0
M0
M0
Surgery
II B T1
T2
N1
N1
M0
M0
Neoadjuvant therapy with or without surgery
III T3
T4
N1
Any N
M0
M0
Neoadjuvant therapy with or without surgery
IV A Any T Any N M1a Chemotherapy or radiation therapy
with or without surgery
IV B Any T Any N M1b Palliative treatment
MANAGEMENT OF ESOPHAGEAL CANCER :-
Because it can be difficult to diagnose esophageal cancer early and diagnosed at rather late
stage, more than 30 percent of patients have metastatic disease at the time of presentation. So
curative treatment has no benefit to this patients & most methods of treatment are palliative
Palliative modalities for esophageal carcinoma :-
(A)Endoscopic Techniques :-
Stent placement.
Laser therapy :-
*Thermal (Nd:YAG).
*Photodynamic therapy.
Dilation.
Electrocoagulation (BICAP probe).
Chemical Injection Therapy.
Nutritional Support :-
*Nasoenteric feeding tube.
*Percutaneous endoscopic gastrostomy (PEG).
(B)Non-Endoscopic techniques :-
Surgery.
Radiation therapy.
*External beam radiotherapy.
*Intraluminal radiotherapy (brachytherapy).
Chemotherapy.