O slideshow foi denunciado.
Utilizamos seu perfil e dados de atividades no LinkedIn para personalizar e exibir anúncios mais relevantes. Altere suas preferências de anúncios quando desejar.

Carcinoma esophagus

228 visualizações

Publicada em

ANATOMY OF ESOPHAUS, EVALUATION & MANAGEMENT OF CA ESOPHAGUS,

Publicada em: Saúde e medicina
  • Entre para ver os comentários

Carcinoma esophagus

  1. 1. CARCINOMA ESOPHAGUS Presented by : Dr. MK Tiwari
  2. 2. EMBRYOLOGY
  3. 3. EMBRYOLOGY
  4. 4. EMBRYOLOGY
  5. 5. ANATOMY
  6. 6. ANATOMY
  7. 7. ANATOMY
  8. 8. ANATOMY
  9. 9. ANATOMY Inferior thyroid artery Tracheobronchial & bronchoesophageal artey Esophageal artery Lt Gastric artery Splenic artery
  10. 10. ANATOMY
  11. 11. ANATOMY
  12. 12. ANATOMY
  13. 13. ANATOMY
  14. 14. ANATOMY
  15. 15. ANATOMY
  16. 16. EPIDEMIOLOGY • 6th leading cause of cancer death • 1% total malignancy and 5-10% of GI malignancy • Most prevalent in Asia & SE Asia. • Most common histological type- Squamous Cell Carcinoma & Adenocarcinoma
  17. 17. RISK FACTORS • Maingot's Abdominal Operations. 13th edition
  18. 18. PATHOGENESIS
  19. 19. BARRETTS ESOPHAGUS • Normal Squamous epithelium replaced by Columnar epithelium • Endoscopy should be performed on patients with severe symptoms of GERD, family history of Barrett’s esophagus or esophageal cancer • location, length, and circumferential involvement should be characterized in accordance with the Prague classification and mucosal nodules should be carefully documented.
  20. 20. BARRETTS ESOPHAGUS • Normal Squamous epithelium replaced by Columnar epithelium • Endoscopy should be performed on patients with severe symptoms of GERD, family history of Barrett’s esophagus or esophageal cancer • location, length, and circumferential involvement should be characterized in accordance with the Prague classification and mucosal nodules should be carefully documented.
  21. 21. DIAGNOSIS BE
  22. 22. PATHOGENESIS BE
  23. 23. HEREDITARY CANCER PREDISPOSITION SYNDROME • Tylosis • Familial Barrett’s Esophagus • Bloom Syndrome • Fanconis Anemia
  24. 24. HEREDITARY CANCER PREDISPOSITION SYNDROME
  25. 25. CLINICAL FEATURES • Progressive Dysphagia • Reflux symptoms • Fatigue • Retrosternal Pain • Anemia • Hoarseness • Tracheoesophageal Fistula
  26. 26. DIAGNOSIS & STAGING
  27. 27. PRINCIPALS OF ENDOSCOPIC SATGING AND THERAPY • Diagnosis • Staging • Primary treatment • Treatment of symptoms • Follow up surveillance
  28. 28. PET CT • Can detect 15-20% metastasis not detected in CT and EUS • Low accuracy in detecting nodal disease • Follow up response to chemo & radiotherapy
  29. 29. DIAGNOSIS & STAGING
  30. 30. DIAGNOSIS & STAGING
  31. 31. DIAGNOSIS & STAGING
  32. 32. DIAGNOSIS & STAGING
  33. 33. TUMOR MARKERS • HER2 • dMMR • MSI-H • PD-L1 • H2 RLN • WDR 66 • PLA2G2A World Journal of Gastrointestinal Oncology. 2014 May 15; 6(5): 112–120.Published online 2014 May 15.
  34. 34. MANAGEMENT CA ESOPHAGUS SURGERY CHEMOTHERAPY RADIATION
  35. 35. PRINCIPLES OF SURGERY• Clinical staging prior to surgery • Tumor should be classified as per Siewarts classification • Diagnostic Lap in Siewert II & III to assess occult mets • In patients with advanced tumors, clinical T3 or N+ disease should be considered for laparoscopic staging with peritoneal washings. • Cervical or cervicothoracic esophageal carcinomas <5 cm from the cricopharyngeus: definitive chemoradiation. • Resectable Esophageal Carcinoma • Unresectable Esophageal Carcinoma
  36. 36. • Transthoracic Esophegectomy • Ivor Lewis Approach(Rt thoracotomy+Laparotomy+Thoracic Anastomosis) • McKewon Approach(Rt thoracotomy+Laparotomy+Cervical anastomosis) • Transhiatal Esophagectomy • Thoraco-abdominal Esophagectomy • Minimally invasive Esophagectomy PRINCIPLES OF SURGERY
  37. 37. IVOR LEWIS APPROACH
  38. 38. TRANS-HIATAL APPROACH
  39. 39. PRINCIPLES OF SURVEILLANCE
  40. 40. PRINCIPLES OF SURVILLANCE
  41. 41. THANK YOU

×