Download MBBS (Bachelor of Medicine and Bachelor of Surgery) 4th Year (Final Year) ENT Neoplasms of Oesophagus Handwritten Notes
LEIOMYOMA
? Most common
? 2/3 of al benign neoplasms
? arises from smooth muscle
? Dysphagia if tumour size>5 cm
? Barium swl ow show ovoid fil ing defect
? endoscopy -submucosal swel ing
? Rx ? enucleation by thoraotomy
MUCOSAL POLYPS
LIPOMAS
FIBROMAS
HAEMANGIOMAS
Are other benign tumours
Often pedunculated and present in oesophageal
lumen
Endoscopic removal avoided because of danger
of perforation
Rx : surgical excision by oesophagotomy
CARCINOMA OESOPHAGUS
Incidence : high in china , japan , Russia, south
africa. In India , 3%of al body Ca in rich and
9.13% of those in poor
Aetiology : SMOKING, ALCOHOLISM ,
TOBACCO
Some dietary habits also contribute
5% arise from pre existing pathological lesions
like benign strictures ,hiatus hernia, cardiac
achalasia, diverticula
Plummer- Vinson syndrome
PATHOLOGY
Squamous cel 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
Cervical & Thoracic spread to supraclavicular
nodes
"Skip Lesions" also present
? BLOOD : metastases to liver, lung, bone,
brain
CLINICAL FEATURES
Early symptoms: substernal discomfort ,
preference of soft or liquid food
Dysphagia
Pain ; referred to back usual y
Aspiration problem: spread cause laryngeal
paralysis, fistula formation leading to cough
hoarseness of voice, aspiration pneumonia ,
mediastinitis.
DIAGNOSIS
BARIUM SWALLOW
OESOPHAGOSCOPY
BRONCHOSCOPY
CT SCAN
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 proximal y and fundus of
stomach distal y can be excised with primary
reconstruction of food channel.
In advanced lesions, only pal iation possible
Alternate food channel provided by:
vA bypass operation
vOesophageal intubation with Celestin or
Mousseau-Barbin or similar tube
vPermanent gastrostomy or feeding
jejunostomy
vLaser surgery: Oesophageal growth is burnt
with Nd: YAG laser to provide food channel.
Chemotherapy used as pal iative measure in
local y advanced or disseminated disease.
PROGNOSIS: 5 year survival is not more than
5-10%
This post was last modified on 11 August 2021