Carcinoma Esophagus 1 Causes Incidence Pathology

4.3 CARCINOMA OF OESOPHAGUS

The incidence of this disorder is variable.

-  In  the  United  States,it varies from  5  cases  per  100,000   

   population in whites to 20 per 100,000 in blacks per year.

-  The incidence is very high in the areas around the Caspian sea   

   North China and Russia.

-  In India the incidence is high in Kashmir and Assam.

The etiology is related to certain factors  principally :

*  Alcohol intake

*  Tobacco use

*  Malnutrition

*  Vitamin deficiency

*  Anaemia and

*  poor oral hygiene.

 

Intake  of  hot food and bevrages have also  been  implicated  in

India.

 

PATHOLOGY

 

  - The  lesion occurs most often (50%) in the mid third  of  the

    oesophagus,  about  a third of the case occur  in  the  lower

    third and upper third is involved in less than 20%

 

  - The lesion is most often (90%) a squamous cell carcinoma  but

    adenocarcinomas can occur at the lower end.

 

  - The tumour spreads through the wall of the oesophagus to  the

    adjoining structures. 

 

  - Spread to regional lymphnodes is also common.

 

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Esophageal disorders benign 4 Tumors

4. TUMOURS

4.1 LEIOMYOMA

 

This  is the most common benign tumour of the  oesophagus.   They

occur in equal frequency in males and females between the ages of

20-50  years.  The majority of these intramural tumour  occur  in

the middle and lower thirds of the oesophagus.

 

They  present  with  dysphagia  small (<5 cm="" span="" style="mso-spacerun: yes;"> 

and  may  have  no

symptoms.  Obstruction and regurgitation occurs in large tumours.

 

TREATMENT

 

The tumour is excised through a thoracotomy (left for lower third

and  right  for  middly  third).   The  longitudinal  fibres   of

oesophagus  split  and the tumours dissected out  -  leaving  the

submucosa intact.  The longitudinal fibres are stiched.

 

4.2 HEMANIGIOMAS

 

These  constitute  2-3%  of all benign  tumours  and  may  remain

symptomless.   They may sometimes cause  successive  hematemesis. 

Laser  therapy through the endoscope provide effective  means  of

treatment.

 

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ESOPHAGEAL Disorders Benign 3 Hiatus Hernia

3.4 HIATUS HERNIA

This  is  a  herniation of the stomach  through  the  oesophageal

hiatus of the diaphragm.

- Type 1 hernia is the more common variety and allows the stomach

  to slide up into the thorax (Sliding hernia)Fig. 15.7

The symptoms are of retrosternal burning after a heavy meal or on

lying down, these symptoms are because of reflux of acid  gastric

content into the oesophagus.

The  acid  gastric  content causes oesophagitis,  the  hernia  is

diagnosed  on  radiology  (barium study) and if  the  patient  is

symptomatic, requires treatment for oesophagitis.

Type  II  hernia  is  rare and also referred  to  as  rolling  or

paraoesophageal hernia,this is a true hernia and has a peritoneal

sac.  Fig. above

Symptoms  of  reflux  are usually absent and in fact  it  may  be

completely asymptomatic.

If  symptomatic  the patient complains of fullness  after  meals,

dysphagia,there may also be stasis. 

Treatment  involves surgical reduction of the hernia excision  of

the sac and repair of the defect in the diaphragm.

 

TREATMENT OF REFLUX : Medical

To reduce regurgitation

*  Elevation of Head end of bed

*  To reduce evening meal size

*  To sleep at least two hours after last meal of the day

*  Antacids to be taken 1 hour after meals

*  Cimetidine may be tried to reduce gastric acidity

 

SURGERY (ANTIREFLUX)

Surgery  is aimed at creating a valve mechanism at the cardia  by

wrapping  the  stomach  around  the  oesophagus  in  the  abdomen

(Nissens)

 

 

Operative correction of esophageral hiatal hernia should

-         return the herniated content to its anatomically correct position below the diaphragm

-         repair the hernia defect

-         prevent recurrence while mainimizing associated morbidity.

 

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Esophageal disorders Benign 2

3.2 PHARYNGOESOPHAGEL DIVERTICULUM

This  is a mucosal pouch between the inferior constrictor of  the

pharynx and criopharyngeus muscle (UES) (Fig.above).

- The patient is between 30-40 years of complaining of  dysphagia

  at the upper end of oesophagus.

- An effortless regurgitation of undigested food.

- There may be gurgling in the neck and

- Some patients compalin of choking and aspiration.

Diagnosis  is made with a barium study and treatment is  surgical

with  excision of the divertication and repair of the  defect  in

the muscle.

 

3.3 PLUMER VINSON SYNDROME (PATERSON-KELLY)

This is a cervical dysphagia in women above the age of 40 years

- These patients have iron  defieciency  anaemia. 

- They manifest atrophic oral mucosa., 

- The  cause   of  dysphagia  is  sometimes  the   presence   of

  demonstrable oesophageal web.

Treatment is with dilatation and correction of the anaemia.

 

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