Esophageal carcinoma. . . . .

Esophageal carcinoma
Squamous cell carcinoma
Adenocarcinoma

1. Group 1 MD8 BSU By- Suryansh Agrawal Esophageal cancer

2. Etiology Risk Factors for Esophageal Squamous Cell Carcinoma (ESCC): Tobacco and Alcohol Use: Both smoking and heavy alcohol consumption are major risk factors for ESCC. Dietary Factors: Diets low in fruits and vegetables and high in nitrosamines and other carcinogens increase risk. Chronic Esophageal Irritation: Conditions causing chronic irritation and inflammation, such as achalasia or caustic injury from ingesting lye, can predispose to ESCC. Human Papillomavirus (HPV): Some studies suggest a potential role for HPV infection in the development of ESCC. Socioeconomic Factors: Lower socioeconomic status is associated with higher ESCC risk, possibly due to differences in diet, healthcare access, and other lifestyle factors.

3. Etiology Risk Factors for Esophageal Adenocarcinoma (EAC): Gastroesophageal Reflux Disease (GERD): Chronic reflux of stomach acid into the esophagus can cause Barrett’s esophagus, a precancerous condition that significantly increases the risk of EAC. Obesity: Increases the risk of GERD and Barrett’s esophagus, thereby contributing to EAC risk. Hiatal Hernia: Often associated with GERD and an increased risk of EAC. Dietary Factors: High-fat diets and low intake of fruits and vegetables are associated with increased EAC risk. Smoking: While more strongly associated with ESCC, smoking is also a risk factor for EAC. Genetic Predisposition: A family history of Barrett’s esophagus or esophageal adenocarcinoma can increase risk.

4. Pathogenesis Genetic Alterations: Mutations: Key mutations in tumor suppressor genes (e.g., TP53) and oncogenes (e.g., KRAS) drive the transformation of normal esophageal cells into cancerous cells. Chromosomal Abnormalities: Loss of heterozygosity and other chromosomal changes are common in esophageal cancers. Epigenetic Changes: Alterations in DNA methylation and histone modification can lead to the silencing of tumor suppressor genes. Inflammation and Cellular Damage: Chronic Inflammation: Persistent inflammation from factors like GERD, tobacco, and alcohol can cause DNA damage and promote cancer development. Oxidative Stress: Reactive oxygen species (ROS) generated during chronic inflammation can lead to DNA damage and mutations. Barrett’s Esophagus to Adenocarcinoma Sequence: Metaplasia: Chronic acid exposure leads to the replacement of squamous epithelium with columnar epithelium (Barrett’s esophagus). Dysplasia: Over time, the metaplastic cells can acquire further genetic and epigenetic changes, progressing to dysplasia (precancerous changes) and eventually to adenocarcinoma. Tumor Microenvironment: Immune Evasion: Cancer cells can evade immune surveillance through various mechanisms, including the expression of immune checkpoint proteins. Angiogenesis: Tumors stimulate the formation of new blood vessels to supply nutrients and oxygen, facilitating further growth and metastasis.

5. Epidemiology Age: Esophageal cancer primarily affects older adults, with the majority of cases occurring in individuals aged 60 and above. Gender: Men are more frequently affected than women, with a male-to-female ratio of approximately 3:1 for ESCC and 7:1 for EAC. Esophageal Squamous Cell Carcinoma (ESCC): Geographic Distribution: More prevalent in developing countries, particularly in parts of China, Iran, and South Africa. Demographics: Historically, more common in men, older adults, and populations with high rates of tobacco and alcohol use. Esophageal Adenocarcinoma (EAC): Geographic Distribution: More common in developed countries, especially in North America and Western Europe. Demographics: Incidence is increasing rapidly, particularly among white males. Associated with obesity, GERD, and Barrett’s esophagus.

6. Signs and symptoms Dysphagia (most common); initially for solids, eventually progressing to include liquids (usually occurs when esophageal lumen < 13 mm) Weight loss (second most common) due to dysphagia and tumor-related anorexia. Bleeding (leading to iron deficiency anemia) Epigastric or retrosternal pain Bone pain with metastatic disease Hoarseness &Persistent cough Frequent pneumonia

7. Complications Obstruction Pain Bleeding Metastasis Fistulas Aspirational pneumonia Malnutrition & weight loss Perforations.

8. Diagnosis Flexible endoscopy with biopsy. Computed tomography (CT) , Positron emisison tomography (PET), endoscopic ultrasonograph( EUS). Bronchoscope Barium swallow Laparoscopy & thoracoscopy.

9. Management Treatment of esophageal cancer varies by disease stage, as follows: Stage I-III (locoregional disease) - Available modalities are endoscopic therapies (eg, mucosal resection or ablation), esophagectomy, preoperative chemoradiation, and definitive chemoradiation. Stage IV – Systemic chemotherapy with palliative/supportive care for patients with ECOG performance score of 2 or less and palliative/supportive care only for patients with ECOG performance score of 3 or more.

10. Bibliography 1. Esophageal Cancer Treatment (Adult) (PDQ®)–Health Professional Version. National Cancer Institute. Available at http://www.cancer.gov/types/esophageal/hp/esophageal-treatment-pdq. February 6, 2024; Accessed: April 24, 2024. 2. ENCCN Clinical Practice Guidelines in Oncology: Esophageal and Esophagogastric Junction Cancers. National Comprehensive Cancer Network. Available at http://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf. Version 2.2024 — April 23, 2024; Accessed: April 24, 2024. 3. Obermannová R, Alsina M, Cervantes A, Leong T, Lordick F, Nilsson M, et al. Oesophageal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Oct. 33 (10):992-1004. [Medline]. [Full Text].