Esophageal cancer its causes,diagnosis and newest treatment

Epidemiology:

                  Esophageal cancer is the sixth leading cause of cancer death worldwide. The incidence of esophageal carcinoma increases with age. The median age of onset is 69 years.  Males are 2 to 4 times more likely to develop esophageal cancer Approximately 10% to 15% squamous cancers originate in the upper third, 35% to 40% in the middle third, and 40% to 50% in the distal third of the esophagus. Adenocarcinomas arise predominately in the distal esophagus and are commonly associated with barrett's esophagus.

                Other less common tumors of the esophagus include lymphoma, carcinosarcoma, pseudesarcoma, squamous adenocarcinoma, melanoma, mucoepidermoid carcinoma, verrucous carcinoma, and malignant carcinoid tumor the esophagus.  Local spread from the lung and thyroid


and metastasis from distant cancers may occur but are rare.

causes

1.    
Chronic use of alcohol and smoking are associated with esophageal carcinoma.

2.     Other conditions with increased prevalence of esophageal carcinoma are lye strictures, achalasia, previous exposure to ionizing radiation, head and neck cancer, Plummer – Vinson syndrome, tylosis, celiac sprue, and Barrett's epithelium.

3.     Adenocarcinoma usually arises from metaplastic columnar epithelium (Barrett's epithelium) and rarely from esophageal glands. 

4.     Adenocarcinoma of the stomach may spread to the esophagus by extension.

5.     Anticholinergics, calcium channel blockers, nitrates, and theophyllines, by decreasing the lower esophageal sphincter tone, are thought to increase the risk of adenocarcinomas of the esophagus. first with solids then with semisolids and liquids, is the most common symptom. 

2. Substernal pain, usually steady, radiating to the back may also be present and may suggest periesophageal spread of the tumor. 

3. Most patients complain of anorexia and profound weight loss. 

4. Patients may have iron-deficiency anemia from blood loss from the lesion, but brisk bleeding is rare.

5. Hoarseness may result from involvement of the recurrent laryngeal nerve. 

6. Patients may aspirate esophageal contents and may present with aspiration pneumonia and pleural effusion. 

7. Horner's syndrome, cervical adenopathy, boney pain, and paraneoplastic syndromes including hypercalcemia, inappropriate ACTH, and gonadotropins may be present.

1. . Diagnosis
   A barium swallow is usually the first noninvasive test ordered to establish the diagnosis of esophageal carcinoma.
2. Endoscopy:  direct biopsies and brushings provide tissue for histologic and cytologic examination.
3. computed tomography (CT) of extramucosal tumor.
4. Endoscopic ultrasonography (EUS): define the anatomy of the gut wall in detail, offers the most accurate method for evaluating the depth of esophageal cancer invasion and detecting abnormal regional lymph nodes.
5.  magnetic resonance imaging (MRI).
6.  Preoperative thoracoscopy and laparoscopy.
7.  Staging and prognosis. T1-2, NOMO are potentially curable with surgery alone.

1. 
   . Treatment
   
   
   The therapy for carcinoma of the esophagus is determined by the stage of the disease.  The mainstay of therapy has been surgery, with or without radiotherapy and chemotherapy.  Inoperable tumors have been treated by radiotherapy because squamous carcinoma of the esophagus is relatively radiosensitive.  Chemotherapy alone has not been very successful.  Treatment protocols combining chemotherapy and radiation therapy before and after surgery offer somewhat better results than single modality therapy.  Most successful chemotherapeutic agents are the combination of cisplatin, 5-fluorouracil, paclitaxel, irinotecan hydrochloride, vinorelbine tartrate, and gemcitabine hydrochloride preoperatively and as neoadjuvant chemotherapy.
   
   
   Surgery. Total esophagectomy is the surgical procedure of choice.                            
2. Radiation therapy.
3. Radiation therapy for squamous cell carcinoma.
4. Presurgical radiation therapy.
5. adenocarcinomas are resistant to radiation therapy.
6. Other palliative measures
7. Mechanical dilatation.
8. tube placement.
9. YAG-laser therapy.
10. Injection necrosis.
11. These palliative measures are usually repeated.
12. Selection of therapy.
13. Prevention and surveillance. 
14.