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《外科教学资料》5.Esophageal cancer.ppt

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《外科教学资料》5.Esophageal cancer.ppt
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1 Esophageal cancer 2 Epidemiology ? Esophageal cancer---a relatively rare China , Iceland , India and Japan , as well as the United Kingdom ? 15,000 new esophageal cancer --in the United States. 30,0000 — in China ? mortality rates 3 林林县县国内国内: :河南居全国之最河南居全国之最江苏、山西、河北、江苏、山西、河北、福建、陕西、安徽、福建、陕西、安徽、湖北、山东、广东湖北、山东、广东 4 ? primarily squamous cell cancer and adenocarcinoma ? Squamous cell cancer arises from the cells that line the upper part of the esophagus ? Adenocarcinoma arises from glandular cells that are present at the junction of the esophagus and stamoch 5 Endoscopic image of patient with esophageal adenocarcinoma seen at gastro-esophageal junction 6 Signs and symptoms Early esophageal cancer usually does not cause symptoms Mid stage — progressive Dysphagia : bulky substances (such as bread or meat )-- Fluids and soft foods Late stage: ? Pain between the shoulder blades ? Hoarseness ? Vomiting ? Coughing up blood ? Bucking( 呛咳) in swallowing ? vomiting up blood ? upper airway obstruction and superior vena cava syndrome ? If the disease has spread elsewhere, this may lead to symptoms related to this : 7 Causes and risk factors Increased risk ? Age. Most patients are over 60 ? Sex. It is mon in men. ? Heredity ? o smoking and heavy alcohol use increase the risk ? Gastroesophageal reflux disease (GERD) and its resultant Barrett's esophagus 8 ? Human papillomavirus (HPV) ? Corrosive injury to esophagus by swallowing strong alkalines ( lye ) or acids. ? Particular dietary substances, such as nitrosamine . ? Obesity increases the risk of adenocarcinoma fourfold ? Drinking large quantities of hot beverages, especially hot brewed teas 9 Decreased risk ? Risk appears to be less in patients using aspirin or related drugs ? green and yellow vegetables and fruits are associated with a decreased risk of esophageal cancer." ? Moderate coffee consumption is associated with a decreased risk. ? eating pizza more than once a week appears "to be a favorable indicator of risk for digestive tract neoplasms in this population." 10 Diagnosis ? barium swallow or barium meal ? endoscopy ; Biopsies ? Computed tomography (CT) ? FDG-PET (positron emission tomography) scan ? Esophageal endoscopic ultrasound (EUS)
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