1、Carcinoma of Esophagus,Speaker:LiuRan,Content,Anatomy of the EsophagusSummaryPathogeny(发病机制)Clinical featureDiagnoseDifferential diagnosisExercise,Anatomy of the Esophagus,The esophagus is a muscular tube, which is a digestive organ between the throat and stomach.,Physiological stenosis of esophagus
2、,First: 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 segmentThe middle segment （Carcinoma occur most frequent） The lower segment,Tracheal bifurcation (气管分叉),Summary,Carcinoma
3、of the 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
4、胺)2. Fungus(真菌)3. Vitamin deficiency4. Dietary habits,Nitrosamine,Nitrosaminescontent of thesefoodsare very high,Clinical feature,In early stage Symptoms are often not obvious, but when swallowing the coarse food ,different degrees of uncomfortable feelings may occur.,Clinical feature,In the middle
5、and advanced stage Progressivedysphagia (进行性吞咽困难) When the tumorinvadethe trachea , tracheoesophageal fistula(气管食管瘘) Cachexia(恶病质),Classification of esophagealcancer,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-raybariummeal2. Computed Tom
6、ography(CT)3. Magnetic Resonance Imaging(MR),1. X-raybariummeal,(1). Early stageEsophagealmucosal folds be beak(粘膜迂曲、断裂)Single ormultiple smallniches(龛影)Limiting filling defect(局限性充盈缺损)Barium streamslow ortemporaryresidence(钡剂流动缓慢或一过性滞留),PostoperationRecur,Smallnodules(小结节),protrude type(隆起型),Earlyu
7、lcerative type,Early 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 tumor,b .Mushroom type,c . Constrictive type,M,63Y, Progressivedysph
8、agia20d,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. Esophagealwall circular or irregular thickening(5mm).2. Cavity lump occurred.3. Paraesophagealfat layerfuzzy,disappear.4. Peripheralorg
9、an got involvedorlymph node metastasis.5. Enhanced scanning showedmild enhancement oftumor.,Enhanced scanning,3. MR,There is a synechia(黏连) between the cancer and the aortic arch.,The high signal fat layer exist.,Cancer invade the trachea,T2WI：The fat layer disappeared and the wall of trachea be dam
10、aged.,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,Intermittentdysphagia(间歇性吞咽困难)On a
11、widened upper segment with fluid levelLower esophagus become thin like a beak(鸟嘴征)Without mucosal fold break.,2. Esophageal varices,Have a history of liver cirrhosis, portal hypertension.Beadedfilling defect(串珠样充盈缺损)Enhanced CT scanshowed vascular tortuositygroup remarkable enhancement and delayeden
12、hancement.Barium emptying delay, but no obstruction phenomenon.,3. Leiomyoma of the esophagus(食管平滑肌瘤),Smooth circular cavity filling defect without mucosal fold break and surrounding tissue invasion and metastasis.,Exercise,1. Can u remember the 3 physiological stenosis of esophagus? (In this question u can answer it in Chinese)2. Please show us the four types of the carcinoma of esophagus.3. Tell me which esophagus disease it is in the following pictures.,Ulcerative carcinoma,The end,Thank you!,
