食管癌英文版

1、Carcinoma of Esophagus,Speaker:LiuRan,Content,Anatomy of the EsophagusSummaryPathogeny(發(fā)病機制)Clinical featureDiagnoseDifferential diagnosisExercise,Anatomy of the Esophagus,The esophagus is a muscular tube, which is

2、 a digestive organ between the throat and

3、 stomach.,Physiological stenosis of esophagus,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 u

4、pper segmentThe middle segment （Carcinoma occur most frequent） The lower segment,Tracheal bifurcation (氣管分叉),,Summary,Carcinoma of the esophagus is a common malignant tumor that occurs in a population cover 40 year

5、s old ,and in predilection for male(好發(fā)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(亞硝胺)2.

6、Fungus(真菌)3. Vitamin deficiency4. Dietary habits,Nitrosamine,,Nitrosamines content of these foods are very high,Clinical feature,In early stage Symptoms are often not obvious, but when swallowing the

7、 coarse food ,different degrees of uncomfortable feelings may occur.,Clinical feature,In the middle and advanced stage Progressive dysphagia  (進(jìn)行性吞咽困難) When the tumor invade the trachea , tracheoeso

8、phageal fistula(氣管食管瘺) Cachexia(惡病質(zhì)),Classification of esophageal cancer,1. Ulcerative type(潰瘍型)2. Mushroom type(蕈傘型)3. Constrictive type(縮窄型)4. Medullary type(髓質(zhì)型),Diagnose,1. X-ray barium meal2. Com

9、puted Tomography(CT)3. Magnetic Resonance Imaging(MR),1. X-ray barium meal,(1). Early stageEsophageal mucosal folds be beak(粘膜迂曲、斷裂)Single or multiple small niches(龕影)Limiting filling defect(

10、局限性充盈缺損)Barium stream slow or temporary residence(鋇劑流動緩慢或一過性滯留),,,PostoperationRecur,,Small nodules(小結(jié)節(jié)),,protrude type(隆起型),,Early ulcerative type,,Early constrictive type,(2). Middle and adva

11、nced stage,a. Ulcerative type(潰瘍型) niche,The surrounding of the tumor become bulged , and the folds of mucous b

12、ecome damaged. (周圍隆起,粘膜皺襞破壞),Filling defectAn expand over the tumor,b .Mushroom type,c . Constrictive type,M,63Y, Progressive dysphagia 20d,d. Medullary type,廣泛侵犯食管全層,形成腔外腫物，管腔狹窄，表面可見潰瘍,The carcinoma can encro

13、ach on the whole-layer of esophagus and make a stenosis,with ulceration on it.,2. CT,1. Esophageal wall circular or irregular thickening(>5mm).2. Cavity lump occurred.3. Paraesophageal fat layer fuzzy

14、, disappear.4. Peripheral organ got involved or lymph node metastasis.5. Enhanced scanning showed mild enhancement of tumor.,,Enhanced scanning,,3. MR,There is a synechia(黏連) between the c

15、ancer 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 damaged.,T1W enhance scanning shows a lump in the trachea and be enhanced li

16、ke the carcinoma.,Differential diagnosis,1. Achalasia of cardia and esophagus(食管賁門失弛緩征)2. Esophageal varices(食管靜脈曲張)3. Leiomyoma of the esophagus (食道平滑肌瘤).,1. Achalasia of cardia and esophagus,Intermittent dy

17、sphagia(間歇性吞咽困難)On a widened upper segment  with fluid levelLower esophagus become thin like a beak(鳥嘴征)Without mucosal fold break.,,2. Esophageal varices,Have a history of liver cirrhosis, portal hypertension.B

18、eaded filling defect(串珠樣充盈缺損)Enhanced CT scan showed  vascular tortuosity group remarkable enhancement and delayed enhancement.Barium emptying delay, but no obstruction phenomenon.,,,3. Leiomyo

19、ma 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