Esophageal Note Path

esophageal anatomy

c4-c10, lies behind trachea, unencapsulated, stratified squamous epithelium, blood vessels

epidemiology & etiology

3:1 M-F ratio, 1% cancer in US, incidence in China, Japan, Finland, Iran, DIET, 60 y/o, GERD

Histopathology: proximal & middle esophagus

squamous cell carcinoma

Histopathology: distal esophagus

adenocarcinoma, develops in glandular tissue

lymphatics upper third

cervical & supraclavicular

lymphatics middle third

posterior mediastinal & retrotracheal

lymphatics lower third

cardia & subdiaphragmatic

regional spread

trachea, mediastinum, lung, plaura, aorta, heart

distant spread

liver, lung, bone, adrenals, brain

signs & symptoms

dysphagia, hoarseness, GERD-like symptoms, cough

detection & diagnosis

barium swallow, US, CT, MRI, PET, bronchoscopy

staging is classified by & why

depth of penetration b/c it is a muscular cancer

RT tx

tumors above aortic arch, tumor 40-45, boost 60-70, 5-8cm margin sup&inf

acute radiation reactions

dysphagia, weight loss, fatigue, perforation, hemorrhage, fistulas

chronic radiation reactions

ulceration & stricture, pneumonitis, pulmonary toxicity

prognosis

40% localized, 21% regional, 4% distant

most important prognostic factors

depth of invasion & met spread