17. EPIDEMIOLOGY
ā¢ 6th leading cause of
cancer death
ā¢ 1% total malignancy
and 5-10% of GI
malignancy
ā¢ Most prevalent in Asia
& SE Asia.
ā¢ Most common
histological type-
Squamous Cell
Carcinoma &
Adenocarcinoma
20. BARRETTS
ESOPHAGUS
ā¢ Normal Squamous epithelium replaced by
Columnar epithelium
ā¢ Endoscopy should be performed on patients
with severe symptoms of GERD, family
history of Barrettās esophagus or esophageal
cancer
ā¢ location, length, and circumferential
involvement should be characterized in
accordance with the Prague classification and
mucosal nodules should be carefully
documented.
21. BARRETTS
ESOPHAGUS
ā¢ Normal Squamous epithelium replaced by
Columnar epithelium
ā¢ Endoscopy should be performed on patients
with severe symptoms of GERD, family
history of Barrettās esophagus or esophageal
cancer
ā¢ location, length, and circumferential
involvement should be characterized in
accordance with the Prague classification and
mucosal nodules should be carefully
documented.
33. PRINCIPALS OF
ENDOSCOPIC SATGING AND
THERAPY
ā¢ Diagnosis
ā¢ Staging
ā¢ Primary treatment
ā¢ Treatment of symptoms
ā¢ Follow up surveillance
34.
35. PET CT
ā¢ Can detect 15-20%
metastasis not
detected in CT and
EUS
ā¢ Low accuracy in
detecting nodal
disease
ā¢ Follow up response to
chemo & radiotherapy
57. PRINCIPLES OF
SURGERYā¢ Clinical staging prior to surgery
ā¢ Tumor should be classified as per Siewarts classification
ā¢ Diagnostic Lap in Siewert II & III to assess occult mets
ā¢ In patients with advanced tumors, clinical T3 or N+ disease
should be considered for laparoscopic staging with peritoneal
washings.
ā¢ Cervical or cervicothoracic esophageal carcinomas <5 cm from
the cricopharyngeus: definitive chemoradiation.
ā¢ Resectable Esophageal Carcinoma
ā¢ Unresectable Esophageal Carcinoma
58. ā¢ Transthoracic Esophegectomy
ā¢ Ivor Lewis Approach(Rt
thoracotomy+Laparotomy+Thoracic Anastomosis)
ā¢ McKewon Approach(Rt
thoracotomy+Laparotomy+Cervical anastomosis)
ā¢ Transhiatal Esophagectomy
ā¢ Thoraco-abdominal Esophagectomy
ā¢ Minimally invasive Esophagectomy
PRINCIPLES OF
SURGERY