食管癌(英文版)

1、Carcinoma of Esophagus Speaker:LiuRanContentAnatomy of the EsophagusSummaryPathogeny(發(fā)病機(jī)制)Clinical featureDiagnoseDifferential diagnosisExerciseAnatomy of the EsophagusThe esophagus is a muscular tube, which is a digestive organ between the throat and stomach.Physiological stenosis of esophagusFirst

2、: The junction of the pharynx(咽) and esophagus.Second: located in the back of left principal bronchus.Third: Esophageal hiatus(食管裂孔). 3 Sections of the esophagus The upper segmentThe middle segment （Carcinoma occur most frequent） The lower segmentTracheal bifurcation (氣管分叉)SummaryCarcinoma of the es

3、ophagus is a common malignant tumor that occurs in a population cover 40 years old ,and in predilection for male(好發(fā)于男性).Prevalence and mortality There are more than 300,000 people worldwide died from esophageal cancer each year , and 150,000 of them are Chinese.Pathogeny1. Nitrosamine(亞硝胺)2. Fungus(

4、真菌)3. Vitamin deficiency4. Dietary habits NitrosamineNitrosaminescontent of thesefoodsare very highClinical feature In early stage Symptoms are often not obvious, but when swallowing the coarse food ,different degrees of uncomfortable feelings may occur.Clinical featureIn the middle and advanced sta

5、ge Progressivedysphagia (進(jìn)行性吞咽困難) When the tumorinvadethe trachea , tracheoesophageal fistula(氣管食管瘺) Cachexia(惡病質(zhì))Classification of esophagealcancer1. Ulcerative type(潰瘍型)2. Mushroom type(蕈傘型)3. Constrictive type(縮窄型)4. Medullary type(髓質(zhì)型)Diagnose1. X-raybariummeal2. Computed Tomography(CT)3. Magnet

6、ic Resonance Imaging(MR)1. X-raybariummeal(1). Early stageEsophagealmucosal folds be beak(粘膜迂曲、斷裂)Single ormultiple smallniches(龕影)Limiting filling defect(局限性充盈缺損)Barium streamslow ortemporaryresidence(鋇劑流動(dòng)緩慢或一過性滯留)PostoperationRecurSmallnodules(小結(jié)節(jié))protrude type(隆起型)Earlyulcerative type Early const

7、rictive type(2). Middle and advanced stagea. Ulcerative type(潰瘍型) niche The surrounding of the tumor become bulged , and the folds of mucous become damaged. (周圍隆起,粘膜皺襞破壞) Filling defectAn expand over the tumorb .Mushroom typec . Constrictive typeM,63Y, Progressivedysphagia20d d. Medullary type廣泛侵犯食管

8、全層,形成腔外腫物，管腔狹窄，表面可見潰瘍The carcinoma can encroach on the whole-layer of esophagus and make a stenosis,with ulceration on it.2. CT1. Esophagealwall circular or irregular thickening(5mm).2. Cavity lump occurred.3. Paraesophagealfat layerfuzzy,disappear.4. Peripheralorgan got involvedorlymph node metasta

9、sis.5. Enhanced scanning showedmild enhancement oftumor.Enhanced scanning3. MRThere is a synechia(黏連) between the cancer and the aortic arch.The high signal fat layer exist.Cancer invade the tracheaT2WI：The fat layer disappeared and the wall of trachea be damaged.T1W enhance scanning shows a lump in

10、 the trachea and be enhanced like the carcinoma.Differential diagnosis1. Achalasia of cardia and esophagus(食管賁門失弛緩征)2. Esophageal varices(食管靜脈曲張)3. Leiomyoma of the esophagus(食道平滑肌瘤).1. Achalasia of cardia and esophagusIntermittentdysphagia(間歇性吞咽困難)On a widened upper segment with fluid levelLower es

11、ophagus become thin like a beak(鳥嘴征)Without mucosal fold break.2. Esophageal varicesHave a history of liver cirrhosis, portal hypertension.Beadedfilling defect(串珠樣充盈缺損)Enhanced CT scanshowed vascular tortuositygroup remarkable enhancement and delayedenhancement.Barium emptying delay, but no obstruction phenomenon.3. Leiomyoma of the esophagus(食管平滑肌瘤)Smooth circular cavity filling defect without mucosal fold break and surrounding tissue invasion and metastasis.Exercise1. Can u remember the 3 physiological stenosis of esophagus? (In this question u can a