Speaking of cancer, let’s move on to talk
about esophageal cancer of two major types.
We had discussed already as to what kind of
cancers may then develop due to irritation.
And by irritation I mean, you have a
patient that’s consuming chemicals.
Such as what?
Alkaline, lye type of chemicals,
or perhaps even smoking.
That’s a type of chemical right?
The smoke itself that
the patient is inhaling.
Of course some of us… some of this could then be entering
the esophagus therefore resulting in irritation quite a bit.
Alcohol - Alcohol is a chemical, big time,
obviously may then cause irritation.
So whenever there are chemicals that are
involved, or even the strictures
that we talked about earlier, whenever you have
such irritation of that nature taking place
persistent and chronically,
understand that the type of cancer that you are going to develop
or the patient develop
will be squamous cell cancer.
“But Doctor Raj, I had this question.
I had this patient in which she was drinking alcohol and
ended up being where she died of adenocarcinoma of the esophagus."
Granted there might have been alcohol involved but
along with that, what else was she probably doing?
She’s probably vomiting quite a
bit, a lot of reflux taking place.
And maybe perhaps she had GERD.
So it’s not the alcohol that was a predisposing
factor to develop adenocarcinoma, alright?
Be careful with that one.
Alcohol consumption, by itself is considered to be a chemical
therefore resulting in squamous cell cancer of the esophagus.
We’ll talk more.
Chronic upper GI blood loss : Iron deficiency
anemia, complication, signs and symptoms.
from solids to liquids.
Anytime that the patient’s losing blood,
always worry about iron deficiency.
The clinical features
should raise “alarms”.
Weight loss, pain - often suggest the spread
of the tumour beyond the wall of esophagus.
So remember, this is a very,
very fast growing type of cancer.
It’ll kill you.
Cough - suggests a malignant
Hoarseness - may be invasion into
the left recurrent laryngeal.
Radiology : You expect to find well,
you do what’s known as esophagram -
demonstrate an “apple core” or obstructive
mass lesion with esophageal cancer.
Endoscopy would be
Radiology would show you,
increase your suspicion of.
However, with definitive biopsy then you would
find what’s known as your cancer of what type.
Well, it depends on the trigger.
Always pay attention to history
for sure, that’ll set the tone.
Chemicals - you’re thinking more along
the lines of squamous cell cancer.
If it’s reflux for whatever type, or caused by
let’s say hiatal hernia in a patient with reflux.
Maybe there was excess of alcohol binge
drinking and so therefore there was vomiting,
vomiting, vomiting, vomiting over a chronic
period of time, that’s adenocarcinoma.
Endoscopy has advantage of potentially being
a diagnostic and therapeutic procedure.
So hence, you really want to pay
attention to your tool - endoscopy.
What we’re seeing here would
be the “apple core” appearance.
On your left would be a
normal barium swallow.
So we’re doing a esophagram
on your imaging study.
However, on the right with
esophageal cancer, you’ll notice that
esophagogram is showing you “apple core” type of appearance.
Imagine you ate an apple and you
eat the core, maybe some of you do
but the point is, the description
is if you’d leave the core behind.
That’s what this kind of looks like if
you can use your imagination properly.
Upon endoscopy, you’ll notice here that
the orifice is extremely narrow for the esophagus,
making it really difficult
for at first, what kind of dysphagia?
Dysphagia to solids first, progressing on to…
look at the caliber, so incredibily narrow.
So even liquids are having a hard
time passing through aren’t they?
But to understand of what type, you
must do endoscopy with biopsy
so that you can find the proper histologic
pattern of this esophageal cancer.
The 5-year survival rate
- ridiculously poor!
7% to 15%
This is scary ladies and gentlemen.
Surgery is the only curative option.
Curative would be surgery, but only if
the tumour is limited to the esophagus.
Remember that sometimes you can have these lateral invasion
and also fistula type of formation with the trachea.
And that makes it more difficult because that
you can’t contain properly.
Squamous cell cancer is more radio-sensitive,
value of chemotherapy is questionable.
So therefore, radiotherapy becomes quite
important to you for squamous cell cancer.
How did the patient… what was the history in the patient
most likely to develop squamous cell cancer of esophagus?
Perhaps chemical type of consumption over a long period of time
or maybe even peptic strictures that we talked about.
Endoscopy can provide
Palliation : So we have laser, dilatation stenting
for luminal compromise or fistula formation.
Talked about earlier, endoscopy being
a very effective tool for palliation.
Not only is it responsible for giving a definitive
diagnosis but could also assist you with the type of
dilation that you’d wish to create
so that you can then obviously facilitate transmission of your foods.