食管癌(英文版)

2. Esophageal varices
• Have a history of liver cirrhosis, portal hypertension. • Beaded filling defect(串珠样充盈缺损) • Enhanced CT scan showed vascular tortuosity group remarkable enhancement and delayed enhancement. • Barium emptying delay, but no obstruction phenomenon.
• The upper segment
Tracheal bifurcation (气管分叉)
• The middle segment
（Carcinoma occur most frequent）
• The lower segment
Summary
• Carcinoma of the esophagus is a common malignant tumor that occurs in a population cover 40 years old ,and in predilection for male(好发于男性).
• • • • 1. Nitrosamine(亚硝胺) 2. Fungus(真菌) 3. Vitamin deficiency 4. Dietary habits
Clinical feature
• In early stage Symptoms are often not obvious, but when swallowing the coarse food ,different degrees of uncomfortable feelings may occur.
广泛侵犯食管全层,形成腔外肿 物，管腔狭窄，表面可见溃疡
2. CT
• 1. Esophageal wall circular or irregular thickening(>5mm). • 2. Cavity lump occurred. • 3. Paraesophageal fat layer fuzzy, disappear. • 4. Peripheral organ got involved or lymph node metastasis. • 5. Enhanced scanning showed mild enhancement of tumor.
Carcinoma of Esophagus
Speaker:LiuRan
Content
• • • • • • • Anatomy of the Esophagus Summary Pathogeny(发病机制) Clinical feature Diagnose Differential diagnosis Exercise
Postoperation Recur
Small nodules(小结节)
protrude type(隆起型)
Early ulcerative type
Early constrictive type
(2). Middle and advanced stage
• a. Ulcerative type(溃疡型) • • niche •
Anatomy of the Esophagus
• The esophagus is a muscular tube, which is a digestive organ between the throat and stomach.
Physiological stenosis of esophagus
Clinical feature
In the middle and advanced stage
Progressive dysphagia (进行性吞咽困难) When the tumor invade the trachea , tracheoesophageal fistula(气管食管瘘) Cachexia(恶病质)
The surrounding of the tumor become bulged , and the folds of mucous become damaged. (周围隆
起,粘膜皱襞破坏)
b .Mushroom type
Filling defect An expand over the tumor
Enhanced scanning
3. MR
The high signal fat layer exist.
There is a synechia(黏连) between the cancer and the aortic arch.
Cancer invade the trachea
T2WI：The fat layer disappeared and the wall of trachea be damaged.
Exercise
• 1. Can u remember the 3 physiological stenosis of esophagus? (In this question u can answer it in Chinese) • 2. Please show us the four types of the carcinoma of esophagus. • 3. Tell me which esophagus disease it is in the following pictures.
Ulcerative carcinoma
The end
• Thank you!
• First: 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
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.
1. Achalasia of cardia and esophagus
• Intermittent dysphagia(间歇性吞咽困难) • On a widened upper segment with fluid level • Lower esophagus become thin like a beak(鸟嘴 征) • Without mucosal fold break.
Prevalence and mortality
• There are more than 300,000 people worldwide died from esophageal cancer each year , and 150,000 of them are Chinese.
Pathogeny
• c . Constrictive type
M,63Y, Progressive dysphagia 20d
• d. Medullary type
The carcinoma can encroach on the whole-layer of esophagus and make a stenosis,with ulceration on it.
T1W enhance scanning shows a lump in the trachea and be enhanced like the carcinoma.
Differential diagnosis
• 1. Achalasia of cardia and esophagus(食管贲门失 弛缓征) • 2. Esophageal varices(食管静脉曲张) • 3. Leiomyoma of the esophagus (食道平滑肌瘤).
Classification of esophageal cancer
• • • • 1. Ulcerative type(溃疡型) 2. Mushroom type(蕈伞型) 3. Constrictive type(缩窄型) 4. Medullary type(髓质型)
Diagnose
• 1. X-ray barium meal • 2. Computed Tomography(CT) • 3. Magnetic Resonance Imaging(MR)
1. X-ray barium meal
• (1). Early stage
Esophageal mucosal folds be beak(粘膜迂曲、断 裂) Single or multiple small (龛影) Limiting filling defect(局限性充盈缺损) Barium stream slow or temporary residence(钡剂 流动缓慢或一过性滞留)