 There two varieties of esophageal tumors worldwide

 Adenocarcinoma
 Squamous cell carcinoma
ADENOCARCINOMA
arise from background of Barret Esophagus and long standing GERD
Risk factors
- long standing dyspepsia
- Tobacco use
- Obesity
- History of irradiation therapy
 More frequent in whites
 M:F = 7:1
 Incidence varies worldwide: common in developed countries like USA, UK. Canada,
Australia and Netherlands. Lowes in Korea, Thailand, Japan and Ecuador
 Clinical presentation
 Early lesions are asymptomatic and diagnosed sometime diagnosed during surveying
GERD or Barret esophagua
 Advance lesions are associated with painful or difficulty swallowing
 Weight loss
 At the time of diagnosis the tumor has spread to sub-mucosal lymphatic vessels
 Tumor limited to to mucosa or sub-mucosa pt has 5 year survival rate of appx.85%
 Tumor spread to submucosa lymphatic vessel has 5 year survival rate of appx. 25%
 Squamous cell carcinoma
 occurs in adult above 45 years
 More males than female M:F = 4:1
 Risk factors
 Alcohol and tobacco use
 Poverty
 Caustic esophageal injury
 Achalasia
 Plummer-Vinson syndrome
 Consumption of hot beverages
 Previous radiation therapy
 Pathogenesis
 In Europe and USA esophageal SCC is associated with alcohol and tobacco use.
 In less developed area esophageal SCC is associated with nutritional deficiencies, food
stuffs contaminated with fungus, nitrosamines , polycyclic hydrocarbons and viral
infection esp. HPV
 Morphology
 About 50% of esophageal SCC occurs in middle third of the esophagus
 SCC starts as area of squamous dysplasia small white plaque –like appearance
 Invasive tumor stage is preceded by carcinoma in situ
 Advanced lesions
 Polypoid and obstruct the lume
 Diffuse invasive lesion which diffusely invading the esophageal wall and causing thickening
 Invasion into surrounding structures like respiratory tree  pneumonia, invasion of
aorta severe hemorrhage

 Clinical Features
 Progressive dysphagia
 Odynophagia
 Patient change diet form solid to liquid foods
 Pt may present with aspiration when there is trachea-esophageal fistula
 Severe wt loss