11 esophageal cancer
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Esophageal CancerEsophageal Cancer
Xiaodong Li 04-02-2010
Thoracic Oncology Department,Cancer center,Sun Yat-Sen University
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Anatomy: Normal EsophagusAnatomy: Normal Esophagus
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Types of Esophageal CancerTypes of Esophageal Cancer
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Epidemiology and Etiology Epidemiology and Etiology
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Ten Leading Cancer Types for the Estimated New
Cancer Cases and Deaths, by Sex, US, 2003
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Worldwide estimates of cancer incidence
Int. J. Cancer 1999, 80:827-841
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Epidemiology and Etiology(1)Epidemiology and Etiology(1)
• An estimated 16,470 new cases in the United States in 2008
• Nearly four times more common among men than women
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Epidemiology and Etiology(2)Epidemiology and Etiology(2)
• Incidence of esophageal cancer has increased six-fold in the past three decades
• Incidence rates of adenocarcinoma have increased recently, especially in the Western hemisphere
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Risk Factor(1)Risk Factor(1)
• Age 65 or older
• Being male
• Smoking• Heavy drinking
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Risk Factor(2)Risk Factor(2)
• Diet:
• Obesity: increase the risk of adenocarcinoma
• Acid reflux
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Symptoms and SignsSymptoms and Signs
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Symptoms of Esophageal CancerSymptoms of Esophageal Cancer
• Dysphagia• Vomiting• Weight loss• Coughing• Back pain• Hoarseness
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Signs Signs of Esophageal Cancerof Esophageal Cancer
• Supraclavicular lymph node metastasis
• Liver mass
• Bone metastasis
• Hydrothorax
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DiagnosisDiagnosis
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How is Esophageal Cancer Diagnosed?How is Esophageal Cancer Diagnosed?
• Barium swallow (esophagram)• Upper endoscopy (Esophagoscopy) and biopsy
(Diagnosis is confirmed with a biopsy)• Endoscopic ultrasound• Bronchoscopy• Computed tomography (CT) scan• Magnetic resonance imaging (MRI)• Positron emission tomography (PET) scan
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DiagnosisDiagnosis (1) (1)
Barium swallow (Esophagram)Barium swallow (Esophagram)
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2020
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DiagnosisDiagnosis (2) (2)
Upper EndoscopyUpper Endoscopy (Esophagoscopy) (Esophagoscopy) and Biopsy and Biopsy
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Pathology diagnosis - Pathology diagnosis - Upper endoscopyUpper endoscopy
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Diagnosis (3)
Endscopic ultrasonography (EUS)
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Endscopic ultrasonography (EUS)Endscopic ultrasonography (EUS)
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Endoscopic ultrasonography (EUS)Endoscopic ultrasonography (EUS)
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DiagnosisDiagnosis (4) (4)
CTCT
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DiagnosisDiagnosis (5) (5)
• MRI • PET-CT• Bronchoscopy• Laparoscopy
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StagingStaging
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Other regular tests
TNM stage
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T stageT stage (Tumor) (Tumor)
TisT1
T2T3
T4
Mucosa
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T1T1
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T2T2
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T3T3
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N stage (lymph node)N stage (lymph node)
N0 N1
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M stage (metastasis)M stage (metastasis)
M1bM1a
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Classification of Stage Groupings Classification of Stage Groupings
for Esophageal Cancerfor Esophageal Cancer
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Stage I Esophageal CancerStage I Esophageal Cancer
• Cancer is in the mucosa and submucosa (the two inside layers of the esophagus)
• Cancer cells are in the lining of the esophagus
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Stage IIA Esophageal CancerStage IIA Esophageal Cancer
• Cancer is in either of the two outer layers of the esophagus
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Stage IIB Esophageal CancerStage IIB Esophageal Cancer
• Cancer is in the inner layers of the esophagus
• Cancer has spread to some lymph nodes near the tumor
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Stage III Esophageal CancerStage III Esophageal Cancer
• Cancer is in the outside layer of the esophagus or in the tissue near the esophagus
• Cancer has spread to lymph nodes, either near the tumor or somewhere
else in the body
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Stage IVA Esophageal CancerStage IVA Esophageal Cancer
• Cancer has spread to the lymph nodes in the abdomen or neck
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Stage IVB Esophageal CancerStage IVB Esophageal Cancer
• Cancer has spread to other parts of the body besides the lymph nodes
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TreatmentTreatment
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How to design the treatment planHow to design the treatment plan
• Stagingwhether the cancer has invaded nearby structureswhether the cancer has spread to lymph nodes or other organs
• where the cancer is located within the esophagus
• The general health of patient
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Treatment of Esophageal CancerTreatment of Esophageal Cancer
EMR or SurgerySurgery
Surgery+adjuvant therapy
Chemoradiotherapy
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RegimenRegimen
• Endoscopic Mucosal Resection(EMR)• Surgery• Chemotherapy• Radiotherapy• Combined-modality therapy• Palliative Therapy
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Endoscopic Mucosal Resection(EMR)Endoscopic Mucosal Resection(EMR)
• What’s EMR?
• Indication of EMR
Tis or T1a (defined as tumor involving the mucusa but not involving submucosa)
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SurgerySurgery
• The most common treatment
• 5-year survival rates of 15% to 30% are reported
• Esophagectomy: removal of part of the esophagus; remaining portion is connected to the stomach
• Lymph nodes around the esophagus may also be removed
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Indication of operationIndication of operation
1 early stage ( stage 0, 1)1 early stage ( stage 0, 1)2 middle stage (stage 2, 3)2 middle stage (stage 2, 3)3 tumor recurrence after radiotherapy 3 tumor recurrence after radiotherapy (no distal metastasis). (no distal metastasis). 4 palliative treatment 4 palliative treatment
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Contraindications of operationContraindications of operation
1 the lesion is extensive,or 1 the lesion is extensive,or involvement of adjacent structures involvement of adjacent structures such as trachea, lung, mediastinum.such as trachea, lung, mediastinum.2 left supraclavicular lymph nodes 2 left supraclavicular lymph nodes metastasis or other distal metastasis.metastasis or other distal metastasis.3 serious functional defection of heart 3 serious functional defection of heart lung and liver. serious cachexia. lung and liver. serious cachexia.
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RadiotherapyRadiotherapy
• Squmous cell carcinoma of the esophagus are radiosensitive and potentially radiocurable
• Radiotherapy to a dose of 6000 cGy resulted in 1-,2-,3- and 5-year survival rates of 33%,12%,8% and 7%
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ChemotherapyChemotherapy
• Chemotherapy alone is seldom an effect palliative modality in patient. Commonly in combination with radiotherapy
• Methotrexate,bleomycin,cisplatin,5-fluorouracil have been used in squmous cell carcinoma
• cancerChemotherapy may be given after surgery (adjuvant), before surgery (neoadjuvant) or if surgery is not possible; in this case, cisplatin and 5-FU are used.
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Combined-modality therapy:Combined-modality therapy:
• Is the best treatment for advanced esophageal cancer. Combined-modality therapy can improve the 3- and 5-year survival rates.
• Including: Surgery+chemotherapy Surgery+radiotherapy Chemotherapy+radiotherapy Radiochemotherapy+surgery
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Palliative TherapyPalliative Therapy
• Photodynamic Therapy
• Laser therapy
• Esophageal stenting
• Feeding gastrostomy
• Colonic interposition
• External-bean irradiation
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What Is the Prognosis for What Is the Prognosis for Esophageal Cancer?Esophageal Cancer?
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PrognosisPrognosis
Time (month)
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In summaryIn summary
• What’s the sympotom and signs of esophageal cancer?
• What’s the main pathologic type of esophageal cancer?
• How can we design the treatment according the staging of esophageal cancer?
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