Presentation for esophageal cancer .pptx

Presentation for Malaria.pdf

1. Esophageal cancer Dr / Fatema abdulwhab

2. Date Your Footer Here Rarely , other cancers, such , small cell carcinoma , or non epithelal carcinoma as (lymphoma, as melanoma, sarcoma ) can occur in the oesophagus 90% are squamous cell carcinomas & occur in the upper or middle third of the esophagus are adenocarcinoma occur in the lower third of the esophagus. 10% Benign tumours The most common is a leiomyoma. This is usually asymptomatic but may cause bleeding or dysphagia. Carcinoma of the oesophagus Tumours of the oesophagus

3. Date Your Footer Here 3 Epidemiology Oesophageal cancer is the eight most common type of cancer worldwide and constitutes the sixth leading cause of cancer death Sex : ♂ > ♀ (4:1) Median age of onset : between 60 and 70 years of age . Squamous cell carcinoma ( SCC ): most common type of esophageal cancer worldwide .

4. 01 02 03 Endogenous risk factor Plummer-Vinson syndrome Achalasia Tylosis Diverticula Older age (60–70 years Male sex Male sex

5. 01 02 03 Alcohol. Tobacco. Post-caustic stricture Smoking Diet low in fruits and vegeta Nitrosamines exposure Exogenous risk factors

6. 01 02 03 Radiotherapy Esophageal candidiasis  HPV HPV Exogenous risk factors certain food or spices

7. Obesity GERD Barrett's esophagus Adenocarcinoma Risk factor

8. Date Your Footer Here 8 Pathophysiology Oesophageal cancer arises in the mucosa of the oesophagus. it then progresses locally to invade the submucosa and the muscular layer, and may invade contiguous structures such as the tracheobronchial tree, the aorta, or the recurrent laryngeal nerve. metastasis typically occurs to the peri-oesophageal lymph nodes, liver, and lungs .

9. Date Your Footer Here Pathology Annular stricture type : The commonest type b.Ulcerative type : rare ♦ The ulcer show features of malignancy, (describe it). c.Proliferative type: very rare . ♦ It form a bulky fungating cauliflower mass with ulceration, necrosis, hge & infection .

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11. Date Your Footer Here 11 Early stages  [ 10] Often asymptomatic May manifest with swallowing difficulties or retrosternal discomfort Advanced stages  [10] General signs Weight loss  Dyspepsia Signs of anemia  Signs of advanced disease Progressive dysphagia  (from solids to liquids) with possible odynophagia Retrosternal chest or back pain Cervical adenopathy  Hoarseness and/or persistent cough  Horner syndrome Signs of upper gastrointestinal bleeding   Hematemesis Melena

12. Date Your Footer Here 12 Clinical features Dysphagia : ⧫ It is the commonest presenting symptoms but it is a late feature ⧫ Dysphagia is recent , rapidly progressive , continuous first to solid only , then to soft diet and lastly in advanced cases to fluids .

13. Date Your Footer Here 14 I) Laboratory investigations: 1. Occult blood in stool : usually positive . 2. Blood picture : usually show anaemia. 3. Tumor markers : CEA , CA19-9 & CA125 evaluate response to treatment and follow up of the patient Investigations

14. Date Your Footer Here 15 II) Radiological investigations : 1. Ba. swallow: may show ⧫ Irregular narrowing with mild proximal dilatation. ⧫ Shouldering, ⧫ Rat tail appearance ⧫ Irregular filling defect. apple core lesion ) 

15. Your Footer Here 16 2. U/S & endoscopic U/S i s very important to detect local extent of the tumor , mediastinal invasion and lymph nodes enlargement . 3. C.T. scan : chest and upper abdomen. 4. PET scan (positron emission tomography scan) : show local tumor , nodal & distal metastases for accurate stagi ng . 5. PET-CT : A PET scan and CT scan may be done at the same time.

16. Date Your Footer Here 17 The investigation of choice is upper gastrointestinal endoscopy with cytology and biopsy  (Confirm the diagnosis) Investigations

17. Date Your Footer Here 18 IV ) Investigations to detect metastasis : (Mention in any malignancy) 1. Plain x-ray : chest & bone to detect lung & bone metastases . 2. U/S of chest , abdomen & pelvis . 3. CT & MRI for brain , bone , chest & abdomen . 4. Radioactive isotopic scan of lung , liver , bone & brain . 5. PET scan & PET-CT. 6. Aspiration of pleural effusion or ascites show hemorrhagic fluid containing malignant cells . 7. Laryngoscopy and bronchoscop y to detect spread to the RLN & tracheo-bronchial tree. 8) Thoracoscopic and laparoscopic exploration with biopsy . ⁕ Any old patient presents with progressive dysphagia and marked weight loss is highly suspicious of esophageal malignancy and indication for endoscopic

18. Date Your Footer Here 19 The treatment of choice is surgery if the patient presents at a point at which resection is possible. For very early superficial tumours, endoscopic submucosal dissection Management Adenocarcinomas are not radiosensitive and surgery is mainstay of treatment. Squamous cell carcinomas can be treated with either surgery or radiotherapy.

19. Date Your Footer Here 20 Treatment Curative Indication Locally invasive disease that has not invaded surrounding structures High-grade metaplasia in Barrett syndrome Methods Neoadjuvant chemoradiation : as definitive treatment in patients with proven complete response (e.g., during endoscopy) Surgical resection Endoscopic submucosal resection for removal of superficial, epithelial lesions  [14][15] Subtotal or total  esophagectomy  with gastric pull-through procedure or colonic interposition 

20. Date Your Footer Here 21 Palliative Indication : patients with advanced disease (majority of patients) Methods Chemoradiation Stent placement   Other endoscopic treatments (e.g., laser therapy)  Treatment

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22. Date Management

23. Date Your Footer Here 24 Monocional Antibodies ( MABs ( They are MABS designed to bind to specific protein targets on the surface of cancer cells or immune cells .

24. Date targeted therapies TARGETING KEY SIGNALING PATHWAYS Targeting the EGFR pathway Targeting the HER2 pathway Targeting the VEGF/VEGFR pathway Targeting the HGF/c-Met pathway Targeting the mTOR-related pathway

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26. IMMUNOTHERAPY PD-1/PD-L1-targeted therapy CTLA4-targeted therapy

27. Date Your Footer Here 28 Dostarlimab (Jemperli):  Nivolumab Pembrolzumab

28. 01 02 03 Ramucirumab (Cyramza®): a monoclonal antibody that targets the VEGF/VEGFR2 pathway and inhibits tumor blood vessel growth; approved for subsets of patients with advanced gastroesophageal cancer Trastuzumab (Herceptin® ): a monoclonal antibody that targets the HER2 pathway; approved for subsets of patients with advanced, HER2-positive gastroesophageal cancer, including as a first-line therapy 03 02 Trastuzumab deruxtecan (Enhertu® ) : an antibody-drug conjugate that targets the HER2 pathway; approved for subsets of patients with advanced gastroesophageal cancer 01 There are six FDA-approved immunotherapy options for esophageal cancer.

29. 01 02 03 02 03 01 Immunomodulators Dostarlimab (Jemperli):  a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced esophageal or gastroesophageal cancer that has DNA mismatch repair deficiency (dMMR) Nivolumab (Opdivo®):   a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced esophageal or gastroesophageal cancer Pembrolizumab (Keytruda® ) : a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced esophageal or gastroesophageal cancer

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31. 01 02 03 04 Complications Spread Bleeding Perforation Pulmonary complic ations ,

32. Date : A) Direct spread : ⧫ Intra-mural : Circumferential & longitudinal microscopic spread beyond palpable edge of the tumor. ⧫ Extra-mural : To the surrounding structures (thyroid, trachea, R.L.N. , lung, pleura , aorta, pericardium , diaphragm , liver .. Lymphatic spread : By permeation and embolization to the para- esophageal L.Ns then to the following lymph nodes . ⧫ Cervical part : to deep cervical L.Ns. ⧫ Thoracic part : posterior mediastinal , tracheal , trachea-bronchial & posterior diaphragmatic L.Ns ⧫ Abdominal part: para-oesophageal , left gastric then celiac L.Ns . Complications Spread

33. Date Your Footer Here C) Blood Spread : ( 2L + 2B or LBLB ) ⧫ Cervical & Thoracic parts : mainly to the to lungs, bones ( ribs & thoracic vertebrae ) , brain via systemic circulation. ⧫ Abdominal part : mainly to the liver via portal circulation. I. Bleeding : haematemesis and melena. III. Obstruction: Very common → dysphagia →malnutrition IV. Perforation : May occur → mediastinitis → mediastinal abscess. V . Pulmonary complic ations , infections , anaemia , cachexia an

34. Date Your Footer Here 35 Prognosis (even in complete resection the 40% of patient die within 1 year) . Overall 5 year survival is very poor and is at best 10%. Adenocarcinoma has poorer prognosis than Squamous cell carcinoma.

35. Thank You!