BENIGN NEOPLASMS
- LEIOMYOMA
- Most common
- 2/3 of all benign neoplasms
- arises from smooth muscle
- Dysphagia if tumour size>5 cm
- Barium swallow show ovoid filling defect
- endoscopy -submucosal swelling
- Rx – enucleation by thoractomy
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- MUCOSAL POLYPS
- LIPOMAS
- FIBROMAS
- HAEMANGIOMAS
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Are other benign tumours
Often pedunculated and present in oesophageal lumen
Endoscopic removal avoided because of danger of perforation
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Rx : surgical excision by oesophagotomy
CARCINOMA OESOPHAGUS
- Incidence : high in china, japan, Russia, south africa. In India, 3%of all body Ca in rich and 9.13% of those in poor
- Aetiology : SMOKING, ALCOHOLISM, TOBACCO
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Some dietary habits also contribute
5% arise from pre existing pathological lesions like benign strictures ,hiatus hernia, cardiac achalasia, diverticula
Plummer- Vinson syndrome
PATHOLOGY
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Squamous cell Ca – most common (93%)
AdenoCa- (3%), seen in lower oesophagus and maybe an upward extension of gastric Ca
- SPREAD
- DIRECT
- LYMPHATIC: cervical, mediastinal, coeliac nodes involved
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Cervical & Thoracic spread to supraclavicular nodes
“Skip Lesions” also present
- BLOOD : metastases to liver, lung, bone, brain
CLINICAL FEATURES
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- Early symptoms: substernal discomfort, preference of soft or liquid food
- Dysphagia
- Pain; referred to back usually
- Aspiration problem: spread cause laryngeal paralysis, fistula formation leading to cough hoarseness of voice, aspiration pneumonia, mediastinitis.
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DIAGNOSIS
- BARIUM SWALLOW
- OESOPHAGOSCOPY
- BRONCHOSCOPY
- CT SCAN
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Rx
- Radiotherapy is Rx of choice since surgery is difficult due to large vessels
- Surgery preferred if lower 1/3 involved . The affected segment, with wide margin of oesophagus proximally and fundus of stomach distally can be excised with primary reconstruction of food channel.
- In advanced lesions, only palliation possible
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- Alternate food channel provided by:
- A bypass operation
- Oesophageal intubation with Celestin or Mousseau-Barbin or similar tube
- Permanent gastrostomy or feeding jejunostomy
- Laser surgery: Oesophageal growth is burnt with Nd: YAG laser to provide food channel. Chemotherapy used as palliative measure in locally advanced or disseminated disease.
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- PROGNOSIS: 5 year survival is not more than 5-10%
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