Epidemiology and etiological factors
The incidence of SCC is decreasing in contrast to adenocarcinoma. SCC of the oesophagus is more common in men. High levels of alcohol consumption increase the risk of squamous cell cancer of esophagus, while tobacco use is associated with an increased incidence of both squamous and adenocarcinomas.
Clinical features
Dysphagia is progressive and unreleting. Initially there is difficulty is swallowing solids, but typically dysphagia for liquids follows within weeks. The lesion may be ulcerative, proliferative or scirrhous, extending variably around the wall of the oesophagus to produce a stricture. Weightless due to the dysphagia as well as to anorexia is frequent.
Investigation
Endoscopy
Barium swallow
Staging using CT and endoscopic ultrasounds. Laparoscopy is useful if the tumours is at the cardia to look for peritoneal and node metastasis. Positron emission tomography (PET) after fluorodeoxyglucose is used to confirm distant metastases suspected on CT.
Treatment
Surgery provides the best chance of a cute but should only be used when imaging has shown that the tumour hasn't infiltrated outside the oesophageal wall.
Chemoradiation. Preoperative (neo-adjuvant) chemoradiation therapy may benefit patients with stage 2b and 3 disease.
Palliative therapy is often the only realistic possibility. Dilatation is only of short-term benefit and the perforation risk is higher than for benign strictures. Combination of endoscopic dilatation with laser or brachytherapy prolongs luminal patency and gives as good if not better functional results than stenting. Insertion of an expanding metal stent allows liquids and soft food to be eaten.
Other options photodynamic therapy, chemoradiation alone.
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| Esophageal stent - Pallative therpy |
Other oesophageal tumors
Gastrointestional stromal tumours and leimyomas are found usually by chance. Kaposi-sarcoma is found in the oesophagus as well as the mouth and hypopharynx in patients with AIDS.
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