1、Carcinoma of EsophagusSpeaker:LiuRanContentAnatomy of the EsophagusSummaryPathogeny(发病机制 )Clinical featureDiagnoseDifferential diagnosisExerciseAnatomy of the Esophagus The esophagus is a muscular tube, which is a digestive organ between the throat and stomach.Physiological stenosis of esophagusFirs
2、t: The junction of the pharynx(咽 ) and esophagus.Second: located in the back of left principal bronchus.Third: Esophageal hiatus(食管裂孔 ).3 Sections of the esophagus The upper segment The middle segment（ Carcinoma occur most frequent） The lower segmentTracheal bifurcation (气管分叉 )Summary Carcinoma of t
3、he esophagus is a common malignant tumor that occurs in a population cover 40 years old ,and in predilection for male(好发于男性 ).Prevalence and mortality There are more than 300,000 people worldwide died from esophageal cancer each year , and 150,000 of them are Chinese.Pathogeny 1. Nitrosamine(亚硝胺 )2.
4、 Fungus(真菌 )3. Vitamin deficiency4. Dietary habitsNitrosamineNitrosamines content of these foods are very highClinical feature In early stageSymptoms are often not obvious, but when swallowing the coarse food ,different degrees of uncomfortable feelings may occur.Clinical featureIn the middle and ad
5、vanced stageu Progressive dysphagia (进行性吞咽困难 )u When the tumor invade the trachea , tracheoesophageal fistula(气管食管瘘 )u Cachexia(恶病质 )Classification of esophageal cancer 1. Ulcerative type(溃疡型 ) 2. Mushroom type(蕈伞型 ) 3. Constrictive type(缩窄型 ) 4. Medullary type(髓质型 )Diagnose 1. X-ray barium meal 2.
6、Computed Tomography(CT) 3. Magnetic Resonance Imaging(MR)1. X-ray barium meal (1). Early stageEsophageal mucosal folds be beak(粘膜迂曲、断裂)Single or multiple small niches(龛影 )Limiting filling defect(局限性充盈缺损 )Barium stream slow or temporary residence(钡剂流动缓慢或一过性滞留 )PostoperationRecurSmall nodules(小结节 )pro
7、trude type(隆起型 )Early ulcerative typeEarly constrictive type(2). Middle and advanced stage a. Ulcerative type(溃疡型 ) niche The surrounding of the tumor become bulged , and the folds of mucous become damaged. (周围隆起 ,粘膜皱襞破坏 )Filling defectAn expand over the tumorb .Mushroom type c . Constrictive typeM,
8、63Y, Progressive dysphagia 20d d. Medullary type广泛侵犯食管全层 ,形成腔外肿物，管腔狭窄，表面可见溃疡The carcinoma can encroach on the whole-layer of esophagus and make a stenosis,with ulceration on it.2. CT 1. Esophageal wall circular or irregular thickening(5mm). 2. Cavity lump occurred. 3. Paraesophageal fat layer fuzzy,
9、 disappear. 4. Peripheral organ got involved or lymph node metastasis. 5. Enhanced scanning showed mild enhancement of tumor.Enhanced scanning3. MRThere is a synechia(黏连 ) between the cancer and the aortic arch.The high signal fat layer exist.Cancer invade the tracheaT2WI： The fat layer disappeared
10、and the wall of trachea be damaged.T1W enhance scanning shows a lump in the trachea and be enhanced like the carcinoma.Differential diagnosis 1. Achalasia of cardia and esophagus(食管贲门失弛缓征 ) 2. Esophageal varices(食管静脉曲张 ) 3. Leiomyoma of the esophagus (食道平滑肌瘤 ).1. Achalasia of cardia and esophagus Intermittent dysphagia(间歇性吞咽困难 ) On a widened upper segment with fluid level Lower esophagus become thin like a beak(鸟嘴征 ) Without mucosal fold break.
