Esophageal carcinoma

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Carcinoma of the oesophagus is a common condition accounting for 10 pet cent of gastrointestinal malignancies. Oesophageal carcinoma arises in the mucosa. Subsequently, it tends to invade the submucosa and the muscular layer and, eventually, contiguous structures such as the tracheobronchial tree, the aorta, or the recurrent laryngeal nerve. The tumor also tends to metastasize to the periesophageal lymph nodes and, eventually, to the liver, lungs, or both. . Alcohol, tobacco, Barrett oesophagus, asbestosis, tylosis, coeliac disease, Plummer-Vinson syndrome, achalasia, caustic stricture and radiation are known risk factors.

Sonography :
Oesophageal tumours are often diagnosed by endoscope and barium studies. Sonography will occasionally demonstrate an unexplained distal oesophageal mass but its great use is in evaluating the liver, portal and para-aortic nodes and para-oesophageal areas to demonstrate tumour spread. Oesophageal tumour usually spreads longitudinally along the oesophageal wall thus there may be extensive tumour spread without sonographically detectable mass lesions.
Endoscopic ultrasound is the most sensitive test to help determine the depth of penetration of the tumor (T staging) and the presence of enlarged periesophageal lymph nodes (N staging). . Endoscopie ultrasound is ideally suited to TNM staging as it depends on the depth of invasion of cancer and its involvement of various layers of the esophageal wall.
The TNM system
Tl tumor invading submucosa or lamina propria.
T2 invasion of muscularis propria.
T3 invasion of adventitia.
T4 invasion of adjacent structures.
Stage 1 =T1, N0, M0.
Stage II A= T2-3, N0, M0.
Stage II B = T1/2, N1, M0.
Stage III = T3, N 1, M0 or T4, N0/1, M0.
Stage IV=T1-4, N0/1, Ml.
The normal thickness of the intra-abdominal oesophageal wall is 3.8 ± 1.2 mm. The five layers of the esophageal wall are well seen on endoscopic ultrasound enabling such staging. However the ability to stage nodal involvement is limited by the tact that endoscopic ultrasound can detect lymph nodes of the primary tumor. When endoscopic ultrasound is combined with abdominal sonography, liver and upper abdominal lymph node metastases can be detected and peritoneal metastases inferred in the presence of ascites. Esophageal tumor is usually seen as an area of wall thickening which is usually hypoechoic but which may present a more complex echopattern. With cancer penetration the wall differentiation is lost and the smooth outer border of the esophagus is no longer seen. tumor invasion into the echogenic para esophageal fat can be easily detected. Endoscopic ultrasound is also helpful in the follow-up of patients with operative resection of cancer and with non Hodgkin's lymphoma follow-up during radiotherapy or chemotherapy.

Differential
*Acute inflammation or corrosive injury
*Lymphoma.
*Esophagitis or esophageal ulcération.
*Esophageal Crohn's disease.
*Esophageal amyloid.
*Right-sided heart failure.
*Esophageal varices.