hema report- esophageal cancer
TRANSCRIPT
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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
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STANDARD TREATMENT1. Surgery
b. Lymph node removal - Esophageal Stenting
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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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STANDARD TREATMENTSide effects:
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
5-fluorouracil (5-FU)
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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STANDARD TREATMENTSide effects:
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
5-fluorouracil (5-FU)
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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STANDARD TREATMENTSide effects:
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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STANDARD TREATMENTSide effects:
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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80/90
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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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).
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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87/90
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).
Based on histopathological examination of the biopsied specimen,squamous cell carcinoma was diagnosed, and an endoscopic mucosal
resection (EMR) was performed (Fig. b).
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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7/29/2019 Hema Report- Esophageal Cancer
88/90
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).
Based on histopathological examination of the biopsied specimen,squamous cell carcinoma was diagnosed, and an endoscopic mucosal
resection (EMR) was performed (Fig. b).
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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7/29/2019 Hema Report- Esophageal Cancer
89/90
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7/29/2019 Hema Report- Esophageal Cancer
90/90