Hema Report- Esophageal Cancer

7/29/2019 Hema Report- Esophageal Cancer

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ESOPHAGEAL CANCER

Frances Rose L. Alcaraz

BS Clinical Pharmacy


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ESOPHAGUS


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ESOPHAGUS

It is a hollow, musculartube that connects the

throat to the stomach. It

lies behind the trachea

and in front of the spine.


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ESOPHAGUS It is usually between 10 and 13 inches long and is

about of an inch across at its smallest point.


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ESOPHAGUS Food and liquids that are swallowed travel through the

inside of the esophagus to reach the stomach.

Layers of esophagus:

Mucosa

Submucosa

Muscularis propiaAdventitia


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PARTS OF THE ESOPHAGUS

Upper esophageal sphincter

Gastroesophageal junction

Lower esophageal sphincter


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ESOPHAGEAL CANCER


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ESOPHAGEAL CANCER Cancerof the esophagus

Cancer is the result of uncontrolled

growth of cells located in a particular

region of the body.

It is a cancer that occurs in theesophagus.

The cancer starts at the inner layer of

the esophagus and can spread

throughout the other layers of the

esophagus and to other parts of thebody.


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ESOPHAGEAL CANCERTWO MAIN TYPES OF ESOPHAGEAL CANCER


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ESOPHAGEAL CANCERTWO MAIN TYPES OF ESOPHAGEAL CANCER:

1. Squamous cell carcinoma

esophagus is normally lined with squamous cells

can occur anywhere along the esophagus


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ESOPHAGEAL CANCER2. Adenocarcinoma

the very bottom portion of the esophagus and the region where

the esophagus and stomach are joined

gland cells must replace an area of squamous cells

Barretts esophagus


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ESOPHAGEAL CANCER

1. Sarcoma

cancer that arises from

transformed cells in one of a

number of tissues thatdevelop from embryonic

mesoderm

0.1-1.5% of all esophageal

tumors

2. Small cell cancer

highly aggressive tumor

associated with a poor

prognosis 0.05 4% of all esophageal

malignancies

OTHER RARE FORMS OF ESOPHAGEAL CANCER:


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HISTORY OF

ESOPHAGEAL CANCER

The history of esophageal cancer dates back to

ancient Egyptian times, circa around 3000 BC.

3000 BC-1500 BC

Signs of cancer are found on the bones of mummiesfrom ancient Egypt and Peru

1900 BC-1600 BC

Oldest specimen of a human cancer was found in the

remains of a female skull dating back to the Bronze Age 400 BC

Hippocrates proposed the Humoral Theory of Medicine

the term cancer was coined

http://www.rare-cancer.org/history-of-cancer.php and http://www.cancerquest.org/cancer-timeline-3000bc-present.html
http://www.rare-cancer.org/history-of-cancer.phphttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.rare-cancer.org/history-of-cancer.phphttp://www.rare-cancer.org/history-of-cancer.phphttp://www.rare-cancer.org/history-of-cancer.phphttp://www.rare-cancer.org/history-of-cancer.phphttp://www.rare-cancer.org/history-of-cancer.phphttp://www.rare-cancer.org/history-of-cancer.phphttp://www.rare-cancer.org/history-of-cancer.php


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HISTORY OF

ESOPHAGEAL CANCER

980 AD-1037 AD

Avicenna referred a disease as "cancer of the

esophagus.

1042 AD-1136 A.DSymptoms of cancer of the esophagus was described

according to Jorjani by Avicenna.

More than 2000 years ago

Cancer of the esophagus was known as "Ye Ge

1872

Theodore Billroth first to perform an esophageal

resection for carcinoma

http://www.rare-cancer.org/history-of-cancer.php and http://www.cancerquest.org/cancer-timeline-3000bc-present.html
http://www.rare-cancer.org/history-of-cancer.phphttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.cancerquest.org/cancer-timeline-3000bc-present.htmlhttp://www.rare-cancer.org/history-of-cancer.phphttp://www.rare-cancer.org/history-of-cancer.phphttp://www.rare-cancer.org/history-of-cancer.phphttp://www.rare-cancer.org/history-of-cancer.phphttp://www.rare-cancer.org/history-of-cancer.phphttp://www.rare-cancer.org/history-of-cancer.phphttp://www.rare-cancer.org/history-of-cancer.php


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HISTORY OF

ESOPHAGEAL CANCER


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BIG Questions1.

1. Is the condition referred to by ancient Chinese and

Iranian physicians who had no access to modern

medical technology was the same to what is diagnosed

today as cancer of the esophagus on the basis ofradiologic, endoscopic and histologic findings?

2. Can we take the accurate description of esophageal

cancer by ancient Chinese and Iranian physicians tomean a higher incidence of the disease in those areas

in ancient days?


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FINAL Question

How can one use historical

evidence for the existence of an

Esophageal Cancer especially in the

South-Central Asia to support either

environmental or hereditary risk factorsin the etiology of this disease?


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EPIDEMIOLOGY It is estimated that:

14,440 men

3,550 women

will be diagnosed;15,210 men and women

will die of cancer of the esophagus in 2013


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EPIDEMIOLOGY

Incidence Rates by RaceRace/Ethnicity Male Female

All Races 7.7 per 100,000 men 1.8 per 100,000 womenWhite 8.0 per 100,000 men 1.8 per 100,000 womenBlack 8.4 per 100,000 men 2.7 per 100,000 women

Asian/Pacific Islander 3.9 per 100,000 men 1.1 per 100,000 womenAmerican Indian/Alaska

Native6.1 per 100,000 men 2.4 per 100,000 women

Hispanic 5.2 per 100,000 men 1.0 per 100,000 women

From 2006-2010


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EPIDEMIOLOGY

Death Rates by RaceRace/Ethnicity Male Female

All Races 7.6 per 100,000 men 1.6 per 100,000 womenWhite 7.8 per 100,000 men 1.6 per 100,000 womenBlack 7.7 per 100,000 men 2.1 per 100,000 women

Asian/Pacific Islander 3.1 per 100,000 men 0.8 per 100,000 womenAmerican Indian/Alaska

Native6.1 per 100,000 men 1.6 per 100,000 women

Hispanic 4.3 per 100,000 men 0.8 per 100,000 women


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EPIDEMIOLOGY Higher incidence of Esophageal cancer:

Belgium

China

Iran

Iceland India

Japan

United Kingdom

As of 2010 it caused about 395,000 deaths up from

345,000 in 1990.

Squamous cell carcinoma of the esophagus usually

affects African American males.


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SIGNS AND SYMPTOMS

a. Painful or difficult swallowing

b. Weight loss


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SIGNS AND SYMPTOMS

c. Pain behind the breastbone

d. Cough, hoarseness and hiccups


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SIGNS AND SYMPTOMS

e. Indigestion and Heartburn

f. Bleeding manifested by vomiting

blood or passing old blood

with bowel movements


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OTHER MANIFESTING SYMPTOMS

OF ESOPHAGEAL CANCER

Symptoms Caused by Local Tumor Effects Dysphagia

Cough and regurgitation

Odynophagia

Weight loss Upper gastrointestinal bleeding

Symptoms Related to Invasion of Surrounding Structures Respiratory fistula

Hoarseness from recurrent laryngeal nerve invasion

Hiccups from phrenic nerve invasion

Pain caused by local spreadSymptoms Related to Distant Disease

Metastatic disease to the lungs, liver, and central nervous

system

Hypercalcemia


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RISK FACTORS

a. Age

b.Gender


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RISK FACTORSc. Gastroesophageal Reflux Disease

d. Barretts Esophagus


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RISK FACTORSe. Tobacco and alcohol

f. Obesity

g. Diet


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RISK FACTORS

h. Achalasia

i. Tylosis


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RISK FACTORSj. Esophageal webs (Paterson-Kelly syndrome) k. Workplace

exposure

l. History of certain other cancers

m. Human papilloma virus


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PATHOPHYSIOLOGY

GastroesophagealReflux Disease

Metaplasia

Low Grade Dysplasia

High Grade Dysplasia

Adenocarcinoma


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SCREENING AND DIAGNOSIS Can cancer of the esophagus be found early?

Looking for a disease in someone without symptoms is

called screening.

In the United States, screening the general public for

esophageal cancer is not recommended by any professional

organization at this time.

Testing for people at high risk

Many experts recommend that people with a high risk of

esophageal cancer, such as those with Barrett's esophagus,

have upper endoscopy regularly. This testing is repeated even more often if there is high-grade

dysplasia.

Surgery to remove the abnormal area is often advised.

Surgery may not be an option for some patients if they are in

poor health and aren't able to withstand the operation.


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DIAGNOSIS1. Medical history and physical exam


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DIAGNOSIS2. Imaging tests

To help find a suspicious area that might be

cancerous

To learn how far cancer may have spread

To help determine if treatment has been effective

To look for possible signs of cancer recurrence

after treatment


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DIAGNOSISa. Chest x-ray b. Barium swallow


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DIAGNOSISc. Computed tomography d. Magnetic

resonance imaging scan


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DIAGNOSISe. Positron emission tomography (PET) scan


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DIAGNOSIS3. Endoscopy

a. Upper endoscopy


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DIAGNOSISb. Endoscopic ultrasound c. Bronchoscopy


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DIAGNOSISd. Thoracoscopy and laparoscopy


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DIAGNOSIS4. Lab Testing of biopsy samples

a. HER2 testing

b. stool


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DIAGNOSIS5. Other tests

a. CBC

b. stool

STAGING THE


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STAGING THE

ESOPHAGEAL CANCER

Staging is the process of finding out how far a

cancer has spread.

There are three ways that cancer spreads in the body:

Through tissue.

Through the lymph system.

Through the blood.

STAGING THE


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STAGING THE

ESOPHAGEAL CANCER

TNMG staging system of the American Joint

Committee on Cancer (AJCC):

T = tumor

N = nodes

M = metastasized

G = grade

STAGING THE


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STAGING THE

ESOPHAGEAL CANCER

The "T" stage is as follows:

TX - tumor cannot be assessed

Tis - carcinoma in situ

T1 - tumor confined to the inner layer of the esophageal wall

(submucosa , T1a or lamina propria, T1b or submucosa) T2 - tumor invades into the muscular layer of the wall

T3 - tumor invades into the outer layer of the wall (adventitia)

T4 - tumor invades into other structures or organs

o T4a - resectable tumor invading pleura, pericardium, or

diaphragm

o T4b - unresectable tumor invading other adjacent structures,

such as aorta, vertebral body, trachea, etc.

STAGING THE


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STAGING THE

ESOPHAGEAL CANCER

The "N" stage is as follows for any subsite:

NX - nearby lymph nodes cannot be assessed

N0 - no spread to lymph nodes

N1 - tumor spread to 1-2 regional lymph nodes

N2 - tumor spread to 3-6 regional nodes N3 - tumor spread to 7 or more regional nodes

STAGING THE


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STAGING THE

ESOPHAGEAL CANCER

The "N" stage is as follows for any subsite:

NX - nearby lymph nodes cannot be assessed

N0 - no spread to lymph nodes

N1 - tumor spread to 1-2 regional lymph nodes

N2 - tumor spread to 3-6 regional nodes N3 - tumor spread to 7 or more regional nodes

The "M" stage is as follows:

M0 - no tumor spread to other organs M1 - tumor spread to other organs and/or lymph nodes

STAGING THE


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STAGING THE

ESOPHAGEAL CANCER

The G" stage is as follows:

GX - grade cannot be assessed

G1 - cells are well-differentiated

G2 - cells are moderately differentiated

G3 - cells are poorly differentiated G4 - cells are undifferentiated

STAGING THE


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STAGING THE

ESOPHAGEAL CANCER

Location:

It iseitherupper, middle, orlowerbased on where the upper

edge of the tumor is.

Stage grouping: Once the T, N, M, and G categories have been assigned, this

information is combined to assign an overall stage of 0, I, II, III,

or IV.

Some stages are further subdivided into A, B, or C.

****The stage groupings for squamous cell carcinoma and adenocarcinoma are

different. Cancers that have features of both squamous cell and adenocarcinomaare staged as squamous cell carcinomas.

STAGING THE


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STAGING THE

ESOPHAGEAL CANCER

Squamous Cell 0 - Tis, N0, M0, GX or G1

IA -Any locat ion:T1, N0, M0 and

Grade 1 (or Grade unknown)

IB - Any locat ion:T1, N0, M0 and

Grade 2-3 IB - Lower tumor :T2 or T3, N0,

M0 and Grade X or 1

IIA - Upper or mid dle tumor :T2-3,

N0, M0 and Grade X or 1

IIA - Lower tumor :T2-3, N0, M0

and Grade 2-3

IIB - Upper or mid dle tumor :T2-3,

N0, M0 and Grade 2-3

IIB - Any locat ion:T1-2, N1 and M0

Adenocarcinoma

0 - Tis, N0, M0, GX or G1

IA - T1, N0, M0 and Grade 1-2

(or Grade unknown) IB - T1, N0, M0 and Grade 3

- T2 N0, M0 and Grade 1-2 (or

Grade unknown)

IIA - T2, N0, M0 and Grade 3

IIB - T3 N0, M0 and any GT1-2, N1, M0 and any G

STAGING THE


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STAGING THE

ESOPHAGEAL CANCER

Squamous Cell

IIIA - T1 or T2, N2, M0 and any G

- T3, N1, M0 and any G

- T4a, N0, M0 and any G IIIB - T3, N2, M0 and any G

IIIC - T4a, N1 or N2, M0 and any G

- T4b, any N, M0 and any G

- Any T, N3, M0 and any G

IV - Any T, any N, M1 and any G

Adenocarcinoma

STAGING THE


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STAGING THE

ESOPHAGEAL CANCER


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TREATMENTThe treatment that is right for you depends mainly on

the following:

where the cancer is located within the esophagus

whether the cancer has invaded nearby structures

whether the cancer has spread to lymph nodes or

other organs

your symptoms

your general health


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STANDARD TREATMENT1. Surgery

a. Esophagectomy
http://www.cancer.gov/PublishedContent/MediaLinks/559569.html


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STANDARD TREATMENT1. Surgery

b. Lymph node removal - Esophageal Stenting
http://www.cancer.gov/PublishedContent/MediaLinks/559570.html


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STANDARD TREATMENTRisks and side effects of surgery:

1.A heart attack or a blood clot in the lungs or the brain.

2. Pneumonia may develop.

3.After the operation, the stomach may empty too slowly because thenerves that control its contractions can be affected by surgery.

4. Stricturescan form where the esophagus is surgically connected to

the stomach.

5.After surgery, bile and stomach contents can enter the esophagus

because the muscle that normally controls this) is often removed or

changed by the surgery.


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STANDARD TREATMENT2. Radiation Therapy

It uses high-energy x-rays or other types

of radiation to kill cancer cells or keep them from

growing.

Possible side effects of radiation therapy:

Skin changes ranging from sunburn-like to blistering and

open sores

Nausea and vomiting Diarrhea

Fatigue

Painful sores in the mouth and throat

Dry mouth or thick saliva


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STANDARD TREATMENT3. Chemotherapy

It uses drugs to stop the growth of cancer cells.

The way the chemotherapy is given depends on the

type and stage of the cancer being treated. As part of the main (primary) treatment, along with radiation

therapy

Neoadjuvant treatment

Adjuvant treatment

Palliative treatment


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STANDARD TREATMENTMany different chemo drugs can be used to treat esophageal cancer.Common regimens are:

a. Carboplatin and paclitaxel (Taxol) (which may be combined

with radiation)

Carboplatin

MOA: produces predominantly interstrand DNA cross-links

rather than DNA-protein cross-links

PaclitaxelMOA: a novel antimicrotubule agent that promotes the

assembly of microtubules from tubulin dimers and stabilizes

microtubules by preventing depolymerisation


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STANDARD TREATMENTSide effects:

low red blood cell count (anemia) feeling weak or tired

hair loss

numbness, tingling, or burning in your hands or feet (neuropathy)

joint and muscle pain nausea and vomiting

Contraindications

contraindicated in patients who have a history of hypersensitivity

reactions to paclitaxel or other drugs formulated in polyoxyl 35castor oil, NF

should not be used in patients with solid tumors who have baseline

neutrophil counts of


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STANDARD TREATMENTb. Cisplatin and 5-fluorouracil (5-FU) (often combined with

radiation)

Cisplatin

MOA: like carboplastin, itproduces predominantly interstrandDNA cross-links rather than DNA-protein cross-links

5-fluorouracil (5-FU)

MOA: interferes with the synthesis of deoxyribonucleic acid

(DNA) and to a lesser extent inhibits the formation ofribonucleic acid (RNA)


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Stomatitis and esophagopharyngitis (which may lead to sloughing

and ulceration), diarrhea, anorexia, nausea and emesis are

commonly seen during therapy

Leukopenia usually follows every course of adequate therapy with

fluorouracil

hair loss

numbness, tingling, or burning in your hands or feet (neuropathy)

Contraindications Leucovorin calcium may enhance the toxicity of fluorouracil.


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STANDARD TREATMENTc. ECF: epirubicin (Ellence), cisplatin, and 5-FU (especially for

gastroesophageal junction tumors)

Epirubicin

MOA: an anthracycline topoisomerase II inhibitor indicated asa component of adjuvant therapy in patients with evidence of

axillary node tumor involvement following resection


MOA: interferes with the synthesis of deoxyribonucleic acid(DNA) and to a lesser extent inhibits the formation of

ribonucleic acid (RNA)


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Risk of infection

Anaemia

Fatigue

Bladder irritation

Contraindications

contraindicated in patients with baseline neutrophil count < 1500

cells/mm3

not be used in patients with cardiomyopathy and/or heart failure,

recent myocardial infarction, severe arrhythmias

should not be used in patients with hypersensitivity to epirubicin,

other anthracyclines, or anthracenediones or severe hepatic

dysfunction


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STANDARD TREATMENTd. DCF: Docetaxel (Taxotere), cisplatin, and 5-FU

Docetaxel

MOA: a microtubule inhibitor indicated for single agent for

locally advanced or metastatic cancer

Cisplatin

MOA: like carboplastin, itproduces predominantly interstrand

DNA cross-links rather than DNA-protein cross-links


MOA: interferes with the synthesis of deoxyribonucleic acid

(DNA) and to a lesser extent inhibits the formation of

ribonucleic acid (RNA)


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Leukopenia usually follows every course of adequate therapy with

fluorouracil

hair loss

Numbness, tingling, or burning in your hands or feet (neuropathy)

Contraindications

not be used in patients with cardiomyopathy and/or heart failure,

recent myocardial infarction, severe arrhythmias


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STANDARD TREATMENTe. Cisplatin with capecitabine (Xeloda)

Cisplatin

MOA: like carboplastin, itproduces predominantly interstrand

DNA cross-links rather than DNA-protein cross-links

Capecitabine (Xeloda)

MOA: combines with enzymes and changes into compounds

that are then taken up by cancer cells where it might be

activated into the drug 5-fluorouracil (5-FU)


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Mucositis

Stomach pain

Low appetite, eating little

Anemia Dehydration , skin rash or dry, itchy skin

Contraindications:

patients with known dihydropyrimidine dehydrogenase (DPD)

deficiency

patients with severe renal impairment

patients with known hypersensitivity to capecitabine or to any of its

components


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STANDARD TREATMENT4. Chemoradiation therapy

Chemoradiation therapy combines chemotherapy

and radiation therapy.

Possible side effects of chemoradiation therapy:

Nausea and vomiting

Diarrhea

Fatigue

Dry mouth or thick saliva


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STANDARD TREATMENT5. Laser therapy

It uses a laser beam to kill cancer cells.

Possible side effects of laser therapy

Nausea and vomiting

Diarrhea

Fatigue


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STANDARD TREATMENT6. Electrocoagulation

It is the use of an electric current to kill cancer

cells.

Possible side effects of electrocoagulation therapy

Nausea and vomiting

Fatigue

Diarrhea


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OTHER TREATMENT OPTIONS

1. Clinical Trials

It gives you a chance to try the latest in cancer

treatment, but they can't guarantee a cure.

2. Endoscopic mucosal resection

the inner lining of the esophagus is removed with

instruments attached to the endoscope

3. Photodynamic therapy

can also be used to help with symptoms for some

cancers that are too advanced to be removed


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OTHER TREATMENT OPTIONS

4. Laser ablation

It is used to help open up the esophagus when it

is blocked by an advanced cancer.

5. Argon plasma coagulation

It uses argon gas and a high-voltage spark

delivered through the tip of an endoscope.

TREATMENT OPTIONS BY STAGE


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TREATMENT OPTIONS BY STAGEPatient group Treatment Line Treatment

Stage 0 1st oesophagectomy2nd endoscopic resection or ablation

Stage 1Surgical candidate 1st oesophagectomySurgical candidate 1st chemoradiotherapy or radiotherapy aloneNot asurgical candidate 2nd endoscopic ablation stenting brachytherapy for symptom relief

Stage 2Surgical candidate 1st oesophagectomySurgical candidate plus preoperative chemoradiotherapy postoperative chemotherapyNot asurgical candidate 1st chemoradiotherapy or radiotherapy aloneNot asurgical candidate 2nd endoscopic ablation stenting brachytherapy for symptom relief

Stage 3Surgical candidate 1st oesophagectomySurgical candidate plus preoperative chemoradiotherapy postoperative chemotherapyNot asurgical candidate 1st chemoradiotherapyNot asurgical candidate 2nd endoscopic ablation stenting brachytherapy for symptom relief

Stage 4 1st chemotherapyadjunct radiotherapyadjunct endoscopic ablation stenting for symptom relief


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ALTERNATIVE TREATMENT

1. Acupuncture

2. Dietary supplements

3. Diet Changes


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MANAGEMENT1. Follow-up care

2. Help for trouble swallowing, nutrition, and pain

3. Making healthier choices

4. Eating better

5. Rest, fatigue, and exercise

Treatment Options for Recurrent Esophageal Cancer:

Use of any standard treatments as palliative therapy torelieve symptoms and improve quality of life.

Clinical trials.


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PREVENTION

1. Quit smoking or chewing tobacco.

2. Drink alcohol in moderation, if at all.3. Eat more fruits and vegetables.

4. Maintain a healthy weight.


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PROGNOSIS

TNM STAGE 5-YEARSURVIVAL (%)

0

100

1 802A 402B 303 154


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PROGNOSIS IMAGING AND PROGNOSIS

Suzuk i et al :

PET scanning is associated with poorer overall

survival among patients with esophageal orgastroesophageal carcinoma receiving

chemoradiation.

HER-2 AND PROGNOSIS

Prins et al

HER-2 positivity was 12%

Overexpression was 14%


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SUPERFICIAL ESOPHAGEALSQUAMOUS CELL CARCINOMA WITH

BULKY GASTRIC HIATUS LYMPH NODE

METASTASIS: A CASE REPORT

CASE REPORT


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CASE REPORTA 49-year-old man was admitted to a clinic after a tumornear the cardiac area of the stomach was found during a

routine medical check-up.

Esophagogastric endoscopy carried out at another hospital

showed a large, protruding lesion with a smooth surfaceand no ulceration close to the gastric cardia.

CASE REPORT


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CASE REPORTOn computed tomography (CT), the tumorwas found to belocated in the hiatus area. The tumor had a heterogenous

composition and measured 50 x 30 mm in diameter.

CASE REPORT


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CASE REPORTThe patient was diagnosed as having a gastric submucosal

tumoror a gastrointestinal stromal tumor, and a total

gastrectomy was carried out (Fig. a).

On quick section during surgery, a moderately

differentiated squamous cell carcinoma was diagnosed(Fig. b,c).

After the total gastrectomy was completed, the regional

lymph nodes were also dissected, but no lymph nodes

containing squamous cell carcinoma were detected.Postoperatively, fluorodeoxyglucose positron emission

tomography (FDGPET) could not identify the primary

lesion.

CASE REPORT


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CASE REPORTThe patient was also seen in consultation by an otolaryngologist and a

respirologist, but no primary tumor in the head and neck region or in the

respiratory tract was found.

On esophagogastric endoscopy, using the iodine spray technique, an

unstained lesion was identified about 32 cm from the incisor teeth (Fig. a).

CASE REPORT


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Based on histopathological examination of the biopsied specimen,squamous cell carcinoma was diagnosed, and an endoscopic mucosal

resection (EMR) was performed (Fig. b).

CASE REPORT


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The entire resected specimen was sliced with 2 mm interval and examined

histopathologically; the tumorwas diagnosed as moderately differentiated

squamous cell carcinoma, and was found to have penetrated to a depthwithin the submucosal layer.

The deepest point of tumor invasion in all sliced specimens was above the

muscularis mucosae (Fig. c).

CASE REPORT


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The entire resected specimen was sliced with 2 mm interval and examined

histopathologically; the tumorwas diagnosed as moderately differentiated

squamous cell carcinoma, and was found to have penetrated to a depthwithin the submucosal layer.

The deepest point of tumor invasion in all sliced specimens was above the

muscularis mucosae (Fig. c).


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Documents

Hema Report- Esophageal Cancer