Noäi Soi Medic: Esophageal Tumor

TRUNG TAM Y KHOA MED
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM
CME
NOI SOI
MEDIC
ESOPHAGEAL TUMOR
NGUYEN PHUC BAO HUNG, MD
MEDIC 254 Hoa Hao Q. 10 TP. Ho Ch Minh

T: 8357284 8355 136 fax: 8488352543 email: medic@hcm. vnn. vn
EXIT
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SOME REVIEWS OF ANATOMY
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Important clinical endoscopic measurement of the esophagus in adults
CME
MEDIC 254 Hoa Hao Q. 10 TP. Ho
EXIT
TRUNG TAM Y KHOA ME

Relation Between Esophagus and
Adjacent Organs
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Normal mucosa of esophagus
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CLASSIFICATION:
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1- EPITHELIAL TUMORS:
BENIGN ETs :
MALIGNANT ETs:
PAPILLOMA, ADENOMA.
SQUAMOUS CELL CARCINOMA.

ADENOCARCINOMA
ADENOID CYSTIC CARCINOMA
MYCOEPIDEMOID CARCINOMA
ADENOSQUAMOUS CARCINOMA
CARCINOSARCOMA
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2- NON EPITHELIAL TUMORS:
NOI SOI
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Benign nets:
Leiomyoma
Hemangioma
Fibroma
Lipoma
Neurofibroma
Osteochodroma
Glomustumor
Malignant nets:
Leiomyosarcoma
Melanoma
Carcinoid tumor
Choriocarcinoma
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3- TUMOR- LIKE LESIONS:
GLYCOGENIC ACANTHOSIS
NOI SOI
MEDIC
HETEROTOPLAS
CYST
FIBROVASCULAR (FIBROUS) POLYPS
4- SECONDARY TUMORS:
METASTASIS FROM
BRONCHUS
STOMACH
BREAST
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In this course, we only discuss the tumors often

seen in clinical practice
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A. Malignant tumor:
1- Carcinoma of esophagus :
2% of all cancers and 7% of all gastrointestinal

cancers
> 50 yo
In us: 20/ 100000
In japan : 46/ 100000
In binh dan hospital (1965-1977) : 355 cases
Male >> female
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In medic:
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From 1. 1. 99 30. 11 99 : 113/38878 # 0. 3%.

Male: female # 5: 1 (94:19).
40%
40
35
26.
5%
30
25
26. 5%
ESO CANCER
50 YO# 93%
20
15
7%
10
5
0
CME
<50
50-59
60--69
>=70
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Histology :
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Squamous cell carcinoma: 95%
NOI SOI
MEDIC
in BINH DAN hospital
moertel (1973)
IN MEDIC:
80%
98%
84%
Adenocarcinoma :
5%
Adenocarcinoma usually see the lower
third of esophagus (barrett s esophagus)
or extending from cardia orifice
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Etiology:
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unknown
Associated factors:
tobaco, alcohol, achalasia, lye stricture, family,

nutrition, chronic esophagitis and plummer-vinson syndrome.
Diagnosis:
Clinical features:
dysphagia: progresses along with disease

odynophagia.
Hoarseness.
CME
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Chest pain.
Weight lost.
Bronchopumonary symptoms.
Physical examination:( prognosis)
Hepatomegaly
Pneumonia
Cervical, supraclavicular and axillary node
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Diagnostic Studies:
XR: stricture of lumen.

The eroded, coarsened, space occupying lesions
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Endoscopy and biopsy:
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Polypoid
Ulcerative
lesion
Infiltrative
Coarsened large tumor causes stricture of the
lumen of the esophagus.
Biopsy is neccessary to definitive diagnosis.
Other studies :
CT scan of the chest

Endoscopic ultrasound.
CME
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STAGES OF ESOPHAGAL CANCER FOLLOWING TO

WNM (WALL, NODE, METASTASIS).
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Anatomic Staging of the Primary Tumor According
to the Depth of Invasion Using Standard
Landmarks
CME
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Complication :
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Obtruction
Hemorrhage
Perforation
Fistula formation
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Treament:
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Resection of the tumor

Radiation
Chemotherapy
Placement of the prothesis
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Prognosis:
5 year -- survival :
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lower third 5%
Middle third 6%
upper third < 1%
radiation + operation (japan): 20 -- 40%
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Histology: Squamous Cell Carcinoma
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EXIT
TRUNG TAM Y KHOA ME

PHONG
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EXIT
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PHONG
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Histology: Adenocarcinoma
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PHONG
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PHONG
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Histology:squamous Cell Carcinoma
PHONG
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PHONG
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PHONG
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PHONG
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PHONG
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PHONG
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PHONG
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Barretts Esophagus
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Histology:squamous Cell Carcinoma
PHONG
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Xray: esophageal cancer (lower- third
).
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The Endoscopic Ultrasound Imaging
of Esophageal Cancer
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PHONG
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2. Rare malignant tumors:
NOI SOI
MEDIC
Sarcomas of the esophagus :
0, 1- 1, 5% of esophageal cancer
Usually upper third
Dysphagia, esophageal obstruction.
large
tumor
can
directly
compress
of
tracheobronchial tree or heart ( dyspnee,
syncope).
X-ray:
A large polypoid intraluminal esophageal mass.

Obtruction and dilation of the esophagus proximal
to the tumor.
CME
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Endoscopy:
NOI SOI
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Intraluminal necrotic mass.

Polypoid lesion with ulcerated surface
Biopsy.
Ct scan of chest
Histology:
Leiomyosarcoma.
Carcinosarcoma.
Fibrosarcoma.
Rhabdomyosarcoma
Very rare
Treatment:
Surgery.
CME
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Malignant melanoma:
NOI SOI
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Very rare.
Often primary.
A polypoid lesion, black surface.
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B- Benign tumors of the esophagus:
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Incidence: 0, 5%
Pathology:
Arising from mucosal tissue: squamous cell

papilloma, adenoma.
From submucosa and muscular wall: leiomyoma,
lipoma, fibroma, hemangioma.
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Clinical features : silent
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Nonspecial symptoms: dysphagia, bleeding.
Diagnosis:
Tumor is usually incidentally on x-ray

Endoscopy and biopsy help positive diagnosis
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Treatment:
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Follow - up.
Tumor is removed only if it increases rapidly in
size or becomes symptomatic.
Operative or endoscopic removal
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1. Papillomas:
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Wart- like projection on the mucosal surface.

size # 0, 2 -- 0, 5 cm
No symptoms
Endoscopy:
Whitish, slightly elevated nodules.
Round, smooth surface # cyst
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Differential diagnosis:
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Verucous squamous cell carcinoma.
Histology:
Squamous cell papilloma
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SQUAMOUS CELL PAPILLOMA
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PHONG
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2. Leiomyomas:
NOI SOI
MEDIC
50% of all benign esophageal tumor.

Arising from submucosa.
Size: 4-6 x 6-8 cm.
A bulging mass with intact or focally ulcerated
but freely movable mucosa stretched over the
lesion.
Biopsy is not advisable if the overlying mucosal
is normal
Treatment:
Surgery.
CME
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LEIOMYOMA
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PHONG
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3. Myoblastoma:
NOI SOI
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Granular cell tumor.
Endoscopy:
tiny,
slightly
submucosal lesion.
Usually in the distal esophagus.
umbilicated,
Treatment:
endoscopic removing
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MYOBLASTOMA
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4. Hemangioma:
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Rare, 2 - 3% of benign esophageal tumor.

Congenital.
Polypoid lesion, pale bluish coloration.
D# 2--3 cm.
Vascular malformations >> true neoplasm.
Treatment:
Follow- up
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PHONG
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EXIT
TRUNG TAM Y KHOA ME

PHONG
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C. Tumor -- like lesions:
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1. Cysts:
CT SCAN
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CME
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Congenital cyst and acquired retention cyst.

Acquired retention cysts can be caused by
obtruction of the excretory ducts
Asymptomatic.
Round, ovoid, yellowist, smooth surface.
Biopsy or needle may discharge of a mucous
orange - yellow fluid.
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BENIGN EPITHILIAL CYST
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BENIGN EPITHELIAL CYST
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2. Glycogenic acanthosis :
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A benign mucosal lesion.

Size < 1 cm.
Pale or whitish papules.
distal esophagus.
Histology:
Hyperplastic squamous acanthotic epithelium

with increased glycogen content.
Etiology:
Unknown.
Relation gatroesophageal reflux.
CME
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ACANTHOSIS GLYCOGENIC
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D. Conclusion:
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Esophageal cancer is silent killer.

Endoscopy and biopsy are a must if possiple.
Treament: difficult and complex.
Prognosis: poor
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REFERENCES:
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1. Michael v. Sivak, jr. benign and malignant tumor

of esophagus. in: benjamin H. sullivan, jr.
gastroenterologic endoscopy. 1987: 373- 400.
2. Howard M. Spiro. Esophageal disorder: Tumors.
In:Colin E;Atterbury. Kenneth w. Barwick;fred
gorelick;joyce
d.
Gryboski;Cyrus
r.
Kapadia;Adrian reuben. B;Morris traube;Robert
k. Zeman. Mcrau-hill, inc. 1993. 123-137.
3. Jj. Misienicz: Barrettesophagus. Esophageal
carcinoma in:c. I. Bartram;p. B. Cotton;a. S.
Mee;a. B. Price;r. P. H thomson;gastroenterology,
vol 1. Gower medical publishing. London,
1986:38-39;44-51.
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4. Jeffrey H. Peters, Tom R. De meester. Esophagus

and
diaphramatic
hernia.
In:seymour
I.
Schwartz;g. Tom shires;frank c. Spencer; john m,
Daly;josef e. Fisher; aubrey c, galloway, eds.
Singapore:mcgraw-hill, 1999: 1081-1180.
5. Frank h netter. nh khu va cac cho hep
cua thc quan. Frank h. netter;sharon
colacino; eds. atlas giai phau ngi, Tp Ho
Ch Minh, 1995: 239.
6. Bo mon ung th trng hyd tp HCM. Ung th
thc quan. ung th hoc lam sang, tap 2.
Nxbyh, 1986:147--157.
NOI SOI
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EXIT

Noäi Soi Medic: Esophageal Tumor

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TRUNG TAM Y KHOA MED

NGUYEN PHUC BAO HUNG, MD

MEDIC 254 Hoa Hao Q. 10 TP. Ho Ch Minh

TRUNG TAM Y KHOA ME

Important clinical endoscopic measurement of the esophagus in adults

MEDIC 254 Hoa Hao Q. 10 TP. Ho

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

SQUAMOUS CELL CARCINOMA.

MEDIC 254 Hoa Hao Q. 10 TP. Ho

TRUNG TAM Y KHOA ME

2- NON EPITHELIAL TUMORS:

MEDIC 254 Hoa Hao Q. 10 TP. Ho

TRUNG TAM Y KHOA ME

3- TUMOR- LIKE LESIONS:

MEDIC 254 Hoa Hao Q. 10 TP. Ho

TRUNG TAM Y KHOA ME

In this course, we only discuss the tumors often

2% of all cancers and 7% of all gastrointestinal

MEDIC 254 Hoa Hao Q. 10 TP. Ho

TRUNG TAM Y KHOA ME

From 1. 1. 99 30. 11 99 : 113/38878 # 0. 3%.

MEDIC 254 Hoa Hao Q. 10 TP. Ho

TRUNG TAM Y KHOA ME

Squamous cell carcinoma: 95%

MEDIC 254 Hoa Hao Q. 10 TP. Ho

TRUNG TAM Y KHOA ME

tobaco, alcohol, achalasia, lye stricture, family,

dysphagia: progresses along with disease

MEDIC 254 Hoa Hao Q. 10 TP. Ho

TRUNG TAM Y KHOA ME

XR: stricture of lumen.

MEDIC 254 Hoa Hao Q. 10 TP. Ho

TRUNG TAM Y KHOA ME

Endoscopy and biopsy:

CT scan of the chest

MEDIC 254 Hoa Hao Q. 10 TP. Ho

TRUNG TAM Y KHOA ME

STAGES OF ESOPHAGAL CANCER FOLLOWING TO

MEDIC 254 Hoa Hao Q. 10 TP. Ho

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

Resection of the tumor

TRUNG TAM Y KHOA ME

MEDIC 254 Hoa Hao Q. 10 TP. Ho

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME

TRUNG TAM Y KHOA ME