Oesophageal Tumours

Oesophageal Tumours

·        Symptoms & signs:

o   Dysphagia: when disease advanced

o   Inability to swallow saliva

o  Pain

o  Weight loss, anaemia, lymphadenopathy, hepatomegaly

·        Investigations:

o  Endoscopy: biopsy

o  Bloods: FBC (anaemia), ALP (metastases. in liver or bone)

o  CT, MRI: localised tumours

·        Differential diagnosis:

o  Benign stricture

o  Motility disorders, especially achalasia

o  Extrinsic compression of oesophagus (e.g. bronchial carcinoma)

·        Treatment:

o  Adequate nutrition (enteral feeding tube if necessary)

o  Pain management

o  Surgery/radiotherapy: usually only palliative

·        Squamous cell carcinoma:

o  90 % of oesophageal cancer

o  Epidemiology: M>F 4:1, B>W, approx 5 per 100,000

o  Aetiology: dietary (fungal, nitrites, ¯leafy greens), oesophagitis, alcohol, tobacco, genetics

o  Macroscopic appearance: Site: 50% middle, 30% lower, 20% upper.  Early lesion a small grey-

o   white thickening.  Later: fungating tumour, ulceration, infiltration (may present as stricture)

o  Microscopic appearance:

§  Sheets of neoplastic squamous cells with intercellular bridges

§  Keratin whirls Þ well differentiated

§  Mitoses, necrosis, pleomorphism (as with all malignant tumours)

§  Invasion of mediastinal structures and lymphatics 

o  Clinical outcome: Insidious (® late presentation).  70% dead at one year

·        Adenocarcinoma of the oesophagus:

o  10% of oesophageal carcinomas.  Arise in Barrett‟s mucosa

o  Elderly, mainly males

o  Macroscopic: mass or nodule

o  Microscopic: pleomorphism, irregular gland formation