Esophagus Flashcards
______ is a
- Muscular tube located between the pharynx and the stomach
- Starts after the cricoid cartilage around C6 and ends at around TIO
- 25 cm in length
Esophagus
What are the 4 divisions of the esophagus
cervical , upper thoracic , middle thoracic , and lower thoracic
The esophagus is posterior to the
trachea
What are the 3 layers of the esophagus?
mucosal, submucosal, muscular layer
- mucosal inner most layer has 3 divisions
- epithelium - most esophagus cancers
lamina propria
muscularis mucosa
______ is associated with Barrett’s esophagus
Adenocarcinoma
There are lymphatic vessels within the ______layer of the esophagus
submucosa
Esophageal cancer Lymphatic spread can demonstrate
skip metastasis
____thoracic esophagus drains to the internal jugular, cervical,paraesophageal, and supraclavicular node
upper
_____thoracic esophagus drains to the paratracheal, hilar, subcarinal, paraesophageal, and paracardial nodes
middle
x______thoracic esophagus drains to the celiac axis, gastric nodes, and nodes within the lesser curvature of the stomach
lower
________ are common in the upper and middle sections of the esophagus
Squamous cell carcinomas
______are common in the lower section of the esophagus and GE junction. Are also the most common esophageal cancer in US.
Adenocarcinomas
etiology for esophagus
- chronic consumption of hot, highly seasoned foods
- alcohol , tobacco
- chemical exposure
- short esophagus
- Barrett disease
clinical presentation for esophagus
- dysphagia and weight loss most common
- chest pain
- odynophagia
- hoarseness if laryngeal nerve compressed
- SVC syndrome
- hematemesis
what’s typical workup for esophagus
- history and physical
- barium swallowed under fluoroscopy
- esophagoscopy with biopsy
- ultrasound shows depth of invasion through organ layers
- CT
spread patters for esophagus
- local spread - trachea mediastinum lung , pleura , aorta heart
- distant - 53% liver - lung 35% - bone 11%
staging system for Esophagus
TNM
treatment for esophagus
- surgery is standard whenever possible
- pre op or post op radiation to dose to 45 - 50 GY
- radiation alone 60-70 Gy
treatment borders for esophagus
i. AP/PA include GTV, plus generous margin of 5 cm above and below tumor plus regional lymph nodes to 4000 cGy
ii. Off cord (to spare spinal cord) for remainder of dose
iii. Field may be reduced after 4500 cGy to decrease margin to 2.5 cm
