Esophagus

Faleesa, Nick, Jake , Dustin , Holly , Eyob, Bret GX: Grade cannot be assessed G1: Well differentiated G2: Moderately differentiated G3: Poorly differentiatedG4: Undifferentiated || || -modest skin tanning -fatigue -weight loss -pneumonitis rarely occurs, but is a potential serious complication -stenosis and stricture are common. Stenosis can occur in more than 60% of patients receiving additional chemotherapy. || Localized 38% Regional 20% Distant 3% ||
 * **Epidemiolgy:** || Esophageal cancer has a 3 to 4 times higher incidence rate in men compared to women. 1 The black population has a 50% higher incidence rate of disease over the white population. There is also an increase of incidence in northern China, northern Iran, and South Africa. A majority of esophageal cancer is found in patients of 55-85 years of age and is almost always fatal. Rates of survival have improved in the last decade, with 17% of whites and 12% of blacks surviving 5 years after diagnosis. ||
 * **Etiology:** || Risk factors for squamous cell esophageal cancer in western countries includes excessive alcohol and tobacco usage. 1 Tobacco products account for about 50% of the squamous cell cancer. Adenocarcinoma esophageal cancer can be caused by Barrett’s esophagus, gastroesophageal reflux disease, and diets low in fresh fruits and vegetables. Achalasia, Plummer-Vinson syndrome, caustic injury, and tylosis can also cause cancer in the esophagus. ||
 * **Signs & Symptoms:** || The most common signs and symptoms for esophageal cancer are weight loss, odynophagia, and dysphagia. 2 Some of the more advanced tumors can lead to a cough, hemoptysis, hematemesis, and hoarseness when there is involvement of the surrounding nerves. ||
 * **Diagnostic Procedures:** || The most common diagnostic imaging tool used for esophageal cancer is an upper endoscopy. 2 As the tube is able to visualize the inside of the esophagus, the physician can take a biopsy of the tumor as well as visualize the extent of the primary disease. Endoscopic ultrasound (EUS) is also a useful tool when trying to determine the extent of the tumor and possible lymph node involvement. However, to better visualize lymph nodes a computed tomography (CT) scan can help with recognizing metastasis and diagnosis. If needed there is occasionally a positron emission tomography scan that can be fused with the CT for diagnosis. ||
 * **Histology:** || Adenocarcinoma is the leading histology for esophageal cancer over squamous cell. 3 Adenocarcinoma has increased 350% since 1970 and accounts for 75% of all cases in Caucasian males. Squamous cell cancer can be estimated based on what level the cancer is in the esophagus. It is seen in 10%-25% of cases involving the upper third, 40%-50% involving the middle third, and 25%-50% involving the lower third. ||
 * **Lymph node drainage:** || The esophagus has a dual longitudinal interconnecting system of lymphatics. 3 Therefore, the entire esophagus is at risk form lymphatic metastasis. Lymphatics of the esophagus drain into nodes that usually follow arteries, including the inferior thyroid artery, the bronchial and esophageal arteries from the aorta, and the left gastric artery. 3 At the time of autopsy, 70% of patients are found to have lymph node metastases. ||
 * **Metastatic spread:** || Esophageal tumors 5 centimeters (cm) or less in length are often localized. Tumors larger than 5 cm have distant metastasis 75% of the time. 1 The esophagus is at risk for skip metastasis and nodal involvement. Lymphatic spread is unpredictable and may occur at a significant distance from the tumor. ||
 * **Grading:** || Histologic Grade (G) 4 :
 * **Staging:** || Staging of Esophageal Tumors 5
 * **Radiation side effects:** || -Doses greater than 4000-5000 cGy coorelate with acute esophagitis 3
 * **Prognosis:** || Stage 5-Year Relative Survival Rate 6
 * **Treatments:** || Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health.

Surgery 6 Surgery is the removal of the tumor and surrounding tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Surgery has traditionally been the most common treatment for esophageal cancer. However, currently, surgery is used as the primary (first) treatment only for patients with early-stage esophageal cancer.

Chemotherapy and radiation therapy are often given at the same time to treat esophageal cancer. Recent studies also show that chemotherapy alone (without radiation therapy) may work as well, but more research is needed to understand any benefits of chemotherapy alone compared with chemoradiotherapy.

Radiation therapy 6 A total dose of 50-70Gy will be given using external beam radiation therapy. When radiation treatment is given directly inside the body, it is called internal radiation therapy or brachytherapy and the common radioactive isotope used for this treatment are iridium 192.

Reprinted from //Textbook of Radiation Oncology//, 2013. 7 Reprinted from //Textbook of Radiation Oncology//, 2013. 7 || Stomach- 5000 cGy Kidneys- 2300 cGy Liver- 3000 cGy Spinal Cord- 4700 cGy Heart- 4000 cGy Lungs- 1750 cGy ||
 * **TD 5/5:** || Due to the esophagus being a 25 cm long tube, the treatment can involve many normal structures. The normal structures and their TD 5/5 to the whole organ are 1 :
 * **References:** || # Washington CM, Leaver D. //Principles and Practice of Radiation Therapy//. 3rd ed. St. Louis, MO : Mosby Elsevier; 2010.
 * 1) Chao K, Perez C, Brady L. //Radiation Oncology Management Decisions//. 3rd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2011.
 * 2) Chao K, Perez C, Brady L. //Radiation Oncology Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002.
 * 3) NCCN Clinical Practice Guidelines in Oncology: Esophageal and Esophagogastric Junction Cancers. National Comprehensive Cancer Network Web site. []. Accessed June 10, 2013.
 * 4) Esophageal Cancer Cure and Guide. Prognosis Esophageal Cancer and Staging. [] . Accessed June 10, 2013.
 * 5) Esophageal cancer. Cancer.net. [] . Accessed June 10, 2013.
 * 6) Phillips TL, Hoppe R, Roach M. //Textbook of Radiation Oncology//. 3rd ed. Philadelphia, PA: Saunders; 2010. ||

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