Cervical Esophageal Cancer PPT课件.ppt

Cervical Esophageal Cancer
Anatomy
Superior to the manubrium
Superior margin: cricophagyngeus muscle
Inferior limit: suprasternal notch
Precise length: variation
Histology
Mucosa: stratified squamous epithelium
Submucosa, or areolar layer
Muscular layer: external longitudinal and internal circular
Vasculature
Thyroid branch of thyrocervical trunk
Inferior thyroid vein
Nerve Innervations
Derived from vagus nerve via the recurrent laryngeal nerve and from the sympathetic trunks.
The parasympathetic and sympathetic fibers form plexuses between muscle, serving to mediate peristalsis.
Physiology
Active participation in swallowing is the function of cervical esophagus
Upper sphincter: cricopharyngeus
Prevention or reduction of reflux
Epidemiology
< 1% in US newly diagnosed but varies greatly around world.
mon in the Middle East, southern and eastern Africa and Northern China
Etiology
Alcohol
o
Nitrosamines
Head and neck cancer
Achalasia
Second primary of lung or GI ca
Defect of 3p, 9p, 17p
Carcinoma limited to the cervical esophagus is rare. Downward or upward
Squamous cell carcinoma dominant
Adenocarcinoma arises from either gastric mucosa or mucous glands in esophagus.
5% of GERD developed Barrett esophagus. 5% of Barrett esophagus develop malignancy
Evaluation
Primary symptom: dysphagia
The mon abnormal finding is a neck mass (21%)
Laryngoscopy may show pooling of secretions
Vocal cord paralysis
Transmural ration of the trachea is extremely last sign