Cancer of the esophagus

The cancer of the esophagus is a Cancer developing with the level of the Muqueuse of the esophagus and person in charge of 5200 deaths per annum in France.

Risk factors

the sex: it is more frequent at the men.
the age: it increases with the age especially as from 40 years.
exogenic factors:

alcohol
tobacco
deficiencies in vitamins has and B.

the endogenous factors:

œ ** œsophagite S chronicles (by Backward flow gastro-oesophagien. Risk increased +++ in the event of Endobrachyoesophage)

Brûlure S caustics
Irradiation

Symptom

Dysphagie : difficulty of swallowing food, with impression of blocking rétrosternal. The dysphagie of the cancer of the esophagus is progressive: initially with the solids, then with pasty food finally with drinks, worsening quickly.
Slimming
Pain rétrosternale
Hoquet
Voice bitonale

Diagnosis

The key examination of the diagnosis is the Fibroscopie. The observation of a dysphagie, especially at a éthylo-nicotinic subject, must quickly bring to a fibroscopy.

Surface cancer is appeared as a mucous anomaly: eroded mucous membrane, raised, warted. Even in the absence of lesion macroscopically visible, vital colorings can show a zone of abnormal coloring corresponding to areas of cellular rehandling: positive for the toluidine blue, negative for Lugol's solution.

Any suspect zone must give place to a Biopsie. If the tumor is passable, this one is likely all to be positive.

Anatomopathology

Carcinomes épidermoïdes (90%) is more often related to alcoolo-nicotinic consumption. The adenocarcinomists (10%) are more often related to a backward flow gastro-oesophagien, they more often sit at the lower third of the esophagus.

Treatment

the curative surgery : very heavy (the esophagus occupies the stages cervical, thoracic and abdominal, the surgery touches these three stages)
the radiochimiothérapie : with rates of answer complête and cure comparable with those obtained by the surgery: the choice between these two curative treatments must be made by specialized teams.
chemotherapy, the radiotherapy and their association in the event of palliative situation.
the endoscopic methods (endoprothèse; dilations oesophagiennes; tumoral destruction by laser or plasma argon, photofrein and brachythérapie)
the associated care: gastrostomy of food if the patient cannot feed any more by the mouth, treatment of the pain and salivation…

Surgical

The surgery will relate to unfortunately only 30% of the cases (because patient alcoolo-nicotinic which often present cardiac and pulmonary of their intoxication, at the time of discovered tumor, and frequency of other tumors, pulmonary complications or associated ORL). It will be often associated with the pre or postoperative radiochimiothérapie.

It consists in withdrawing the esophagus, and the surrounding ganglionic surfaces, and replacing it either by a tubulized stomach, or by colon, or by small intestine. The ways initially will be abdominal, thoracic, and sometimes cervical.

It is about a very heavy surgery, at often weakened patients: she is thus proposed only with selected patients, with curative aiming. The more so as radio-chemotherapy made great progress in this indication

Radio-chemotherapy

With palliative or curative aiming. Chemotherapy always comprises Cys-platinum, associated with 5-Fluoro-uracil or the Navelbine. The radiotherapy consists of 45 to 60 Gy managed on the tumor, by protecting the heart and the lungs.

It can be used in néo-additive: before an surgical operation, with a benefit in term of hope of survival for the patient.

Follow-up of the patients

Dice the discovery of the cancer of the esophagus, a complete assessment is started: it is advisable to seek the other complications of the alcoolo-nicotinic intoxication:

cardiac: coronary diseases, Cardiomyopathie dilated, arteritis;
pulmonary: chronic bronchitis, emphysema, associated bronchial tumor;
hepatic: cirrhosis;
ORL: tumors of the pharynx or the mouth.

During the follow-up of the patients, all these pathologies can occur, and must be regularly required. In addition one will seek a repetition of the tumor oesophagienne, or another tumor oesophagienne, by fibroscopy oesophagienne; metastases ganglionic, pulmonary, hepatic, surrénaliennes, cutaneous,… by regular scanner, and examinations targeted in the event of clinical signs.

Reference

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