Tumors of The Esophagus

Antonietta G Gravina
Gastroenterology
“Luigi Vanvitelli” University
 Classification
Epithelial (90%)
• Benign
1. squamous papilloma
2. adenoma
3. Inflammatory fibroid polyp
• Malignant
1. esophageal squamous carcinoma
2. Esophageal adenocarcinoma
 Classification
Non Epithelial (10%)
• Benign
1. Leiomyoma
2. Hamartoma
3. Lipoma
• Malignant
1. GIST
2. Lymphoma
3. Sarcoma
 Risk Factors
• Squamous: smoking, alcohol excess, post-
caustic strictures, HPV (papilloma virus),
achalasia, tylosis (familial hypercheratosis of
palms and soles)
• Adenocarcinoma: GERD, obesity, Barrett’s
esophagus
 Clinical Presentation
• Dysphagia (advanced disease): progressive, non painful, for
solids
• Weight loss
• Odynophagia
• Chest pain
• Hiccup (involvement of phrenic nerve and diaphragm)
• Post-swallow coughing: fistulation between esophagus and
tracheal or bronchial tree
• Physical signs: cachexia, cervical limphadenopathy
 Diagnosis
• Serological markers non specific
• Endoscopy with biopsies (at least 6)
• Barium swallow
• Endoscopic Ultra Sonography
• CT scan with and without contrast
enhancement
• PET-CT
Carcinoma of the Esophagus: EGDS
and EUS

Lnode

Neoplasia Aorta
 Screening
Endoscopic surveillance only in patients with Barrett’s esophagus
Biopsies must be taken in the four quadrants at the level of the metaplastic area

• No displasia : EGDS every 3 years

• Low grade dysplasia (LGD): 12 week treatment with high dose PPI
repeat EGDS with biopsies, if LGD confirmed, EGDS
every 6 months for 1 year and, then, every year
• High grade dysplasia (HGD): 27% progression to cancer in 3 years
1. Esophagectomy
2. Mucosectomy or Endoscopic Submucosa Resection