Esophageal Cancer

Xiaodong Li
04-02-2010

Thoracic Oncology Department,Cancer center,Sun Yat-Sen University

Anatomy: Normal Esophagus

Types of Esophageal Cancer

Epidemiology and Etiology

Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths, by Sex, US, 2003

Worldwide estimates of cancer incidence

Int. J. Cancer 1999, 80:827-8418

Epidemiology and Etiology(1)

An estimated 16,470 new cases in the United States in 2008 Nearly four times more common among men than women

Epidemiology and Etiology(2)

Incidence of esophageal cancer has increased six-fold in the past three decades Incidence rates of adenocarcinoma have increased recently, especially in the Western hemisphere

10

Risk Factor(1)
Age 65 or older Being male Smoking Heavy drinking

11

Risk Factor(2)
Diet: Obesity: increase the risk of adenocarcinoma Acid reflux

12

Symptoms and Signs

13

Symptoms of Esophageal Cancer

Dysphagia Vomiting Weight loss Coughing Back pain Hoarseness

14

Signs of Esophageal Cancer

Supraclavicular lymph node metastasis Liver mass Bone metastasis Hydrothorax

15

Diagnosis

16

How is Esophageal Cancer Diagnosed?

Barium swallow (esophagram) Upper endoscopy (Esophagoscopy) and biopsy (Diagnosis is confirmed with a biopsy) Endoscopic ultrasound Bronchoscopy Computed tomography (CT) scan Magnetic resonance imaging (MRI) Positron emission tomography (PET) scan

17

Diagnosis (1) Barium swallow (Esophagram)

18

19

20

Diagnosis (2)
Upper Endoscopy (Esophagoscopy) and Biopsy

21

Pathology diagnosis - Upper endoscopy

22

23

Diagnosis (3) Endscopic ultrasonography (EUS)

24

Endscopic ultrasonography (EUS)

25

Endoscopic ultrasonography (EUS)

26

Diagnosis (4)

CT

27

28

29

Diagnosis (5)
MRI PET-CT Bronchoscopy Laparoscopy

30

Staging

31

TNM stage
Other regular tests

32

T stage (Tumor)
Mucosa
Tis T1
T2 T3 T4

33

T1

34

T2

35

T3

36

N stage (lymph node)

N0 N1

37

38

M stage (metastasis)
M1a M1b

39

Classification of Stage Groupings for Esophageal Cancer

40

Stage I Esophageal Cancer

Cancer is in the mucosa and submucosa (the two inside layers of the esophagus) Cancer cells are in the lining of the esophagus
41

Stage IIA Esophageal Cancer

Cancer is in either of the two outer layers of the esophagus

42

Stage IIB Esophageal Cancer

Cancer is in the inner layers of the esophagus Cancer has spread to some lymph nodes near the tumor
43

Stage III Esophageal Cancer

Cancer is in the outside layer of the esophagus or in the tissue near the esophagus

Cancer has spread to lymph nodes, either near the tumor or somewhere
else in the body

44

Stage IVA Esophageal Cancer

Cancer has spread to the lymph nodes in the abdomen or neck

45

Stage IVB Esophageal Cancer

Cancer has spread to other parts of the body besides the lymph nodes

46

Treatment

47

How to design the treatment plan

Staging whether the cancer has invaded nearby structures whether the cancer has spread to lymph nodes or other organs
where the cancer is located within the esophagus

The general health of patient

48

Treatment of Esophageal Cancer

EMR or Surgery Surgery

Chemoradiotherapy

Surgery+adjuvant therapy
49

Regimen
Endoscopic Mucosal Resection(EMR) Surgery Chemotherapy Radiotherapy Combined-modality therapy Palliative Therapy

50

Endoscopic Mucosal Resection(EMR)

Whats EMR? Indication of EMR Tis or T1a (defined as tumor involving the mucusa but not involving submucosa)

51

Surgery
The most common treatment 5-year survival rates of 15% to 30% are reported Esophagectomy: removal of part of the esophagus; remaining portion is connected to the stomach Lymph nodes around the esophagus may also be removed
52

53

Indication of operation 1 early stage ( stage 0, 1) 2 middle stage (stage 2, 3) 3 tumor recurrence after radiotherapy (no distal metastasis). 4 palliative treatment

54

Contraindications of operation
1 the lesion is extensive,or involvement of adjacent structures such as trachea, lung, mediastinum. 2 left supraclavicular lymph nodes metastasis or other distal metastasis. 3 serious functional defection of heart lung and liver. serious cachexia.

55

Radiotherapy
Squmous cell carcinoma of the esophagus are radiosensitive and potentially radiocurable Radiotherapy to a dose of 6000 cGy resulted in 1-,2-,3- and 5-year survival rates of 33%,12%,8% and 7%

56

Chemotherapy
Chemotherapy alone is seldom an effect palliative modality in patient. Commonly in combination with radiotherapy Methotrexate,bleomycin,cisplatin,5fluorouracil have been used in squmous cell carcinoma cancerChemotherapy may be given after surgery (adjuvant), before surgery (neoadjuvant) or if surgery is not possible; in this case, cisplatin and 5-FU are used.

57

Combined-modality therapy:
Is the best treatment for advanced esophageal cancer. Combined-modality therapy can improve the 3- and 5-year survival rates. Including: Surgery+chemotherapy Surgery+radiotherapy Chemotherapy+radiotherapy Radiochemotherapy+surgery
58

Palliative Therapy
Photodynamic Therapy Laser therapy Esophageal stenting Feeding gastrostomy Colonic interposition External-bean irradiation

59

What Is the Prognosis for Esophageal Cancer?

60

Prognosis

Time (month)
61

62

63

64

In summary
Whats the sympotom and signs of esophageal cancer? Whats the main pathologic type of esophageal cancer? How can we design the treatment according the staging of esophageal cancer?

65

Thanks

66