Osteoporosis 

Mkb 10 malignant neoplasms of the esophagus. Esophageal cancer - description, causes, treatment

The main treatments for esophageal cancer are:
* surgical ,.
* beam ,.
* combined (combining radiation and surgical components).
* complex (representing a combination of surgical, radiation and drug (chemotherapy) methods of treatment).
Low tumor sensitivity to existing chemotherapy drugs, palliative and short-term effects of radiation therapy make surgery the method of choice in the treatment of patients with esophageal cancer.
The history of widespread use of the surgical method for the treatment of esophageal cancer dates back just over 50 years. The use of surgical treatment was restrained by the lack of reliable methods of anesthesia, which significantly lengthened the time of surgery, and the lack of a proven technique for the plastic stage of surgical treatment. This led to the long existence of a two-stage method of surgical treatment. The first stage was the Dobromyslov-Torek operation (extirpation of the esophagus with the imposition of a cervical esophagostomy and gastrostomy), the second stage - plastic surgery of the esophagus using one of the many developed techniques. For plastic surgery, almost all parts of the digestive tract were used: the small intestine and various parts of the large intestine, various methods of plastic surgery with the whole stomach and gastric flaps were used.
There were many ways of placing the graft: pre-sternal, retrosternal, in the bed of the removed esophagus, and even, now practically not used, method of skin grafting.
High postoperative mortality, technical complexity of the intervention, cumbersome system of multi-stage operations - all these factors divided surgeons into two camps.
Most surgeons were in favor of radical removal of the affected organ or part of it in the case of unreleased forms of the disease and did not object to radiation therapy. Other surgeons and oncologists critically evaluated the possibilities of surgical treatment of esophageal cancer, especially its high localization, and preferred methods of radiation therapy.
Improvement of surgical techniques, anesthesia, the choice of optimal treatment tactics have determined the prevailing role of surgical treatment of esophageal cancer.
Modern principles of esophageal cancer surgery:
* maximum safety of the intervention: the correct choice of surgical access and the volume of surgical intervention;
* oncological adequacy: mobilization by the "acute path" according to the principle "from the vessel to the affected organ", the correct sequence of mobilization of the affected organ in order to prevent intraoperative dissemination, monoblock lymph node dissection;
* high functionality: the choice of a rational plastic method, the formation of a technically simple antireflux anastomosis.
Comparative analysis of the effectiveness of single-stage and multi-stage operations showed the advantage of the former in terms of postoperative mortality (6.6%), treatment completion (98%) and long-term results (33% 5-year survival).
When determining the indications for surgical treatment, it is necessary to take into account that esophageal cancer most often affects people aged 60 years and older who have a number of concomitant diseases, especially of the cardiovascular and respiratory systems, which limits the possibility of using operations. In addition, esophageal cancer relatively early leads to malnutrition and disorders of all types of metabolism, which increases the risk of surgery.
Thus, choosing the optimal treatment for each patient with esophageal cancer is a difficult task. In each case, it is necessary to strictly take into account the patient's condition, the degree of malnutrition, the prevalence of the process, the technical capabilities of the operating surgeon, and the provision of adequate postoperative care.
Currently, two main methods of surgical intervention are used:
* Extirpation of the esophagus with plastic isoperistaltic gastric flap with extrapleural anastomosis on the neck in the form of transpleural removal of the esophagus or extrapleural extirpation - transhiatal access. The method allows all parts of the esophagus to be surgically exposed up to the pharynx and even with oropharyngeal resection. Locating the neck anastomosis outside the pleural cavity significantly reduces the risk of anastomotic leakage and is not fatal. At the same time, cases of cicatricial stenosis of the anastomosis are frequent. It should be emphasized that the trachiatric method (without thoracotomy) of esophageal resection has limited application in large tumors. Unfortunately, most of the authors declare the predominance of operations for common tumor processes.
* Resection of the esophagus with simultaneous intrapleural plastic surgery of the esophagus by the stomach - Lewis type surgery. This method practically excludes stenosis of the anastomosis, provides better functional results (absence of reflux esophagitis), but the upper sections of the intrathoracic esophagus remain inaccessible for resection (cervical, upper thoracic regions).
When performing an operation for cancer of the esophagus, it is mandatory to carry out lymphadenectomy in at least two cavities along the zones of lymphogenous metastasis, and when extirpating the esophagus, cervical lymph nodes are also subjected to lymphadenectomy.
Mortality in these types of surgery is in the range of 7-10%. In some cases, in addition to the stomach, the small intestine is used as a transplant.
The Torek-Dobromyslov operation has not lost its significance in cases of the possibility of a one-stage plasty stage (the patient's condition, the technical features of the operation). It should be pointed out the possibility of performing palliative interventions in the form of shunting of tumor stenosis by applying a bypass anastomosis in case of unprofitable cancer of the thoracic region.
In the case of an unresectable tumor, a gastrostomy tube may be applied. Patients with esophageal cancer with a superimposed gastrostomy tube may receive radiation therapy.
Radiation treatment of esophageal cancer remains the only treatment method for most patients, for whom surgical treatment is contraindicated due to their concomitant pathology (pronounced disorders of the cardiovascular, respiratory systems and), when patients are old, patients refuse to undergo surgery. In some cases, radiation treatment is initially palliative in nature (after previously performed laparotomy and gastrostomy).
The use of modern irradiation techniques makes it possible to achieve the disappearance of painful clinical manifestations of the disease in 35-40% of patients.
The aim of the irradiation is to create a therapeutic dose of 60-70 Gy in the area of \u200b\u200bthe irradiated organ. At the same time, in addition to the affected organ, the area of \u200b\u200birradiation should include the areas of lymph nodes, the area of \u200b\u200bpossible metastasis: paraesophageal lymph nodes, the area of \u200b\u200bparacardial lymph nodes, the area of \u200b\u200bthe left gastric artery and celiac trunk, supraclavicular areas. The classical method of irradiation is 5 sessions of radiation therapy per week in a single focal dose of 1.5-2 Gy (classical dose fractionation). In other variants of fractionation, the doses delivered during the day may vary, as may the single focal doses.
Methods of intracavitary irradiation have proven to be very effective in esophageal cancer. Intracavitary radiation therapy is performed using the AGAT VU apparatus. In this case, a thin probe with radioactive cobalt is introduced into the lumen of the esophagus and installed at the level of the lesion. The radiation sources are set 1 cm below and above the defined tumor boundaries. The most favorable should be considered a combination of remote irradiation with intracavitary.
Combined and complex treatment. The desire of oncologists to improve the long-term results of treatment was the reason for the development and application of a combined method combining radiation therapy and surgery. The use of combined treatment is most justified in patients with tumor localization in the middle thoracic esophagus.

Esophageal carcinoma occupies a significant share among all oncological diseases, about 5-7%. More common among men in middle and old age. But in recent years, unfortunately, its rejuvenation has been observed.

Summary of the article:

The middle and lower parts of the esophagus are more susceptible to this pathology.
More often squamous cell cancer or.

Cancer etiology

Unambiguously, the reasons leading to oncology have not been reliably clarified until the end. The prerequisites for esophageal cancer are recognized:

  • eating disorders;
  • traumatic damage to the esophageal mucosa;
  • heredity;
  • bad habits;
  • chronic inflammatory diseases;
  • hereditary predisposition.

Eating disorders include the abuse of food that irritates the gastric mucosa, foods containing small bones or other small potentially irritating mucous elements.

Irritating to mucous membranes from smoking, alcohol, chewing tobacco. For smokers and drinkers esophageal cancer occurs 100 times more often.

Deficiency of vitamins A, B, C, and E, selenium, folic acid negatively affects the esophageal mucosa.

Chronic and inflammatory diseases of the esophagus, ulcers can be reborn into cancer. Proved carcinogenic effect on the mucous membrane of the esophagus, gastric juice, bile. They are thrown here from the stomach during reflux esophagitis.
Injuries to the esophagus of various origins, including thermal and chemical burns, also contribute to the degeneration of the esophageal tissue.
Cicatricial changes, hereditary pathologies (Barrett's disease, tylosis). Contact with mucous dust of metals (arsenic, chromium) with a carcinogenic effect will ultimately lead to malignant transformation.
The relationship between the appearance of cancer and heredity has been proven.

ICD code 10 cancer of the esophagus, depending on the location, ranges from C15 to C15.9.

Cancer manifestations

Non-specific manifestations consist in general complaints, which do not even suggest cancer to the average person. The body temperature periodically rises to subfebrile numbers, sweating appears for no particular reason, appetite decreases, the patient loses weight. Some people report the appearance of an aversion to meat.
Directly the symptoms characteristic of cancer of the esophagus are impaired swallowing (dysphagia). At first, the patient complains of a violation of swallowing only hard food, later the problem is caused by the swallowing of liquids.

More on the topic: Stomach cancer: symptoms, signs and treatment

The patient notes pain behind the sternum or in the interscapular region behind. This symptom is typical for a later stage, when the nerve trunks and organs surrounding the esophagus are involved in the process.

Excessive salivation

The voice becomes quieter, husky. This is due to the growth of the tumor into the nerve plexuses of the chest and the resulting paresis of the vocal cords.
The patient complains of a cough. It can be dry, tormenting, or it can be sputum, bloody, or pus. This indicates the invasion of the tumor into the lung tissue.
Unfortunately, about 40% of cases of the disease do not make themselves felt in any way until the late stage. So the disease can develop for 1 or 2 years. Such a tumor may be an accidental finding on a chest x-ray.

The first signs of esophageal cancer

  1. Dysphagia appears only when the tumor has already occupied about 70% of the lumen of the esophagus. Sometimes people think of stomach cramps, but unlike it, dysphagia in cancer occurs constantly.
  2. Even before the appearance of complaints of impaired swallowing, the patient begins to complain of the sensation of a foreign body when eating, speaks of a scratching sensation behind the breastbone.
  3. Only about 30% have complaints of pain. At first, she only bothers with food intake, then this relationship with food intake disappears, the pain becomes constant.
  4. Esophageal vomiting. It consists in regurgitation of undigested food eaten.
  5. Unpleasant putrid odor from the mouth. As a result of the presence of an obstruction in the esophagus, food is retained and accumulates in front of the obstruction.
  6. Weight loss. This is caused both by cancer intoxication and a decrease in appetite, and by the fact that the patient deliberately refuses to eat due to the fact that the process of eating causes him pain.

Graduation by degrees

There are 4 grades of cancer depending on its size and structure:

  1. Up to 3 cm. Only the mucous membrane is affected.
  2. 3 - 5 cm. Diagnosed with metastases localized in the lymphatic vessels.
  3. 5 - 8 cm. The tumor invades the entire thickness of the esophagus. Has metastases to lymph nodes.
  4. More than 8 cm. Grows into adjacent organs.

More on the topic: Tablets for the treatment of esophageal erosion

Signscancer depends on its degree

  • When 1 degree the patient does not feel any tangible abnormalities, but cancer is already clearly detected on endoscopy of the esophagus.
  • When 2 degrees the disease may still proceed without visible manifestations, but some already have disturbances in the process of swallowing.
  • When 3 degrees all or almost all of the signs of cancer are already showing - weight loss, swallowing problems, pain.
  • When 4 degrees the patient's condition is serious. All signs of cancer are expressed.
    A cancerous tumor can spread along the wall of the esophagus, or it can grow into its lumen.

Treatment and prognosis

The surgical treatment of cancer patients is rather controversial. On the one hand, namely radical surgery gives an effective chance to prolong life. On the other hand, these operations are always complex, very traumatic. The patient needs a lot of strength for a long postoperative period. And these patients are always especially emaciated and exhausted by the disease.

During surgery, the pathologically altered part of the esophagus is replaced by tissue from the stomach or intestines. In this case, both cavities open: chest and abdominal. This is a big load on the body. The postoperative period is long and requires patience and knowledge from the personnel.

The operation is advisable only at stages 1 and 2, it is controversial at stage 3. The complexity of the operation also increases because the most vital organs are located nearby, which not only cannot be removed during tumor growth, but also extremely risky to damage.

Radiation and chemotherapy are also used.

The question of how long they live with such a pathology cannot be answered precisely. The fluctuations of this period are influenced by the patient's age, concomitant diseases, the time of visiting doctors and the level of therapy, metastases, invasion into other organs and the level of aggressiveness of the tumor.
According to averaged data, only 10-15% of all patients survive the 5-year period.
A favorable prognosis is possible only in stages 1 - 2.

Grade 3 is already characterized by the presence of diagnosed metastases. The tumor has already captured all layers of the esophagus and has grown into nearby organs. The choice towards surgical intervention is possible when the patient is stable, which allows him to undergo surgery, a long postoperative nursing period, and also if he insists on the operation.

Esophageal leiomyomas... Two-thirds of benign tumors of the esophagus are leiomyomas - tumors that develop in the muscular membrane of the esophagus and do not involve the mucous membrane in the process. Symptoms... If leiomyomas reach 5 cm or more, patients develop dysphagia. Diagnostics.. Contrast X-ray examination. A limited filling defect with smooth edges and unaltered mucous membrane is revealed in the esophageal wall .. Esophagoscopy is necessary to confirm the diagnosis .. Biopsy is contraindicated due to damage to the mucous membrane, which further complicates surgical treatment. Surgical treatment .. Right-sided thoracotomy and enucleation (husking) of the tumor from the esophageal wall without damaging the mucous membrane in patients with clinical manifestations of the tumor .. Esophageal resection is performed if the tumor is located in the lower part of the esophagus and it is impossible to enucleate it.

Code for the international classification of diseases ICD-10:

  • D13.0

Benign tumors growing in the lumen of the esophagus are papillomas, lipomas, fibrolipomas and myxofibromas. Symptoms: dysphagia, occasionally belching and weight loss. Diagnostics .. Contrast X-ray examination of the esophagus .. Esophagoscopy is performed to confirm the diagnosis and exclude malignant neoplasm. Operative treatment .. Esophagotomy, tumor removal and suturing of the esophagotomy opening .. Small polyps of the esophagus can be removed endoscopically.

ICD-10. D13.0 Benign neoplasm of esophagus

  • Esophageal cancer pathogenesis

    Esophageal carcinoma occurs in the mucous membrane. Subsequently, it penetrates into the submucosal and muscle layers, and can also penetrate into adjacent organs (tracheobronchial tree, aorta, recurrent laryngeal nerve). The tumor is prone to metastases to the paraesophageal lymph nodes, and subsequently to the liver and / or lungs.

    Squamous cell carcinoma is most common in Asia and South Africa. It is 4-5 times more common among the black population, and 2-3 times more often among men than among women. The main risk factors are alcohol abuse and tobacco smoking (in any form). Other risk factors are achalasia, human papillomatosis virus, alkali poisoning (leading to esophageal stricture), sclerotherapy, Plummer-Vinson syndrome, and radiation of the esophagus The role of heredity is not clear, but in 50% of patients with hyperkeratosis of the hands and feet as a result of autosomal dominant genetic changes after 55 years, esophageal cancer is observed in 45.95% of cases.

    Adenocarcinoma develops in the distal esophagus. It accounts for 50% of malignant tumors of the esophagus in whites. Alcohol is not an important risk factor, but smoking contributes significantly to tumor development. It is difficult to distinguish adenocarcinoma of the distal esophagus from adenocarcinoma of the cardia of the stomach that penetrates into the distal esophagus. Adenocarcinoma develops in most cases against the background of Barrett's esophagus, a complication of chronic gastroesophageal reflux. In Barrett's esophagus, during the recovery phase of acute esophagitis, the stratified squamous epithelium of the distal esophagus is replaced by a metaplastic, goblet, glandular epithelium, similar to the intestinal mucosa.

    Other malignant tumors:

    The most common malignant tumors are spindle cell carcinoma (poorly differentiated variant of squamous cell carcinoma), verrucous carcinoma (highly differentiated variant), pseudosarcoma, mucoepidermoid carcinoma, adenoscaly carcinoma, cylindrocytic carcinoma (adenocytic carcinoma) (adenocytic carcinoma) (adenoidal carcinoma) primary malignant melanoma.

    Metastatic tumors account for 3% of all tumors of the esophagus. Most often, melanoma and breast cancer metastasize to the esophagus. There are metastases of tumors of the brain, neck, lungs, stomach, liver, kidneys, prostate, testicles, and bones. Tumor metastases usually colonize the esophageal stroma, while primary esophageal cancer initially develops in the mucosa or submucosa.

    • www.smed.ru

    Esophageal cancer - a disease of drinkers and smokers

    Esophageal cancer occupies a significant proportion of all cancers, about 5-7%. More common among men in middle and old age. But in recent years, unfortunately, its rejuvenation has been observed.

    The middle and lower parts of the esophagus are more susceptible to this pathology. More often squamous cell cancer or adenocarcinoma.

    Cancer etiology

    Unambiguously, the reasons leading to oncology have not been reliably clarified until the end. The prerequisites for esophageal cancer are recognized:

    • eating disorders;
    • traumatic damage to the esophageal mucosa;
    • heredity;
    • bad habits;
    • chronic inflammatory diseases;
    • hereditary predisposition.

    Eating disorders include the abuse of food that irritates the gastric mucosa, foods containing small bones or other small potentially irritating mucous elements.

    Irritating to mucous membranes from smoking, alcohol, chewing tobacco. In smokers and drinkers, esophageal cancer occurs 100 times more often.

    Deficiency of vitamins A, B, C, and E, selenium, folic acid negatively affects the esophageal mucosa.

    Chronic and inflammatory diseases of the esophagus, ulcers can be reborn into cancer. Proved carcinogenic effect on the mucous membrane of the esophagus, gastric juice, bile. They are thrown here from the stomach during reflux esophagitis. Injuries to the esophagus of various origins, including thermal and chemical burns, also contribute to the degeneration of the esophageal tissue.

    Cicatricial changes, polyps, hereditary pathologies (Barrett's disease, tylosis). Contact with mucous dust of metals (arsenic, chromium) with a carcinogenic effect will ultimately lead to malignant transformation.

    The relationship between the appearance of cancer and heredity has been proven.

    The ICD 10 code for esophageal cancer, depending on the location, ranges from C15 to C15.9.

    Cancer manifestations

    Non-specific manifestations consist in general complaints, which do not even suggest cancer to the average person. The body temperature periodically rises to subfebrile numbers, sweating appears for no particular reason, appetite decreases, the patient loses weight. Some people report the appearance of an aversion to meat. Directly the symptoms characteristic of cancer of the esophagus are impaired swallowing (dysphagia). At first, the patient complains of a violation of swallowing only hard food, later the problem is caused by the swallowing of liquids.

    The patient notes pain behind the sternum or in the interscapular region behind. This symptom is typical for a later stage, when the nerve trunks and organs surrounding the esophagus are involved in the process.

    Excessive salivation

    The voice becomes quieter, husky. This is due to the growth of the tumor into the nerve plexuses of the chest and the resulting paresis of the vocal cords. The patient complains of a cough. It can be dry, tormenting, or it can be sputum, bloody, or pus. This indicates the invasion of the tumor into the lung tissue. Unfortunately, about 40% of cases of the disease do not make themselves felt in any way until the late stage. So the disease can develop for 1 or 2 years. Such a tumor may be an accidental finding on a chest x-ray.

    The first signs of esophageal cancer

    1. Dysphagia appears only when the tumor has already occupied about 70% of the lumen of the esophagus. Sometimes people think of stomach cramps, but unlike it, dysphagia in cancer occurs constantly.
    2. Even before the appearance of complaints of impaired swallowing, the patient begins to complain of the sensation of a foreign body when eating, speaks of a scratching sensation behind the breastbone.
    3. Only about 30% have complaints of pain. At first, she only bothers with food intake, then this relationship with food intake disappears, the pain becomes constant.
    4. Esophageal vomiting. It consists in regurgitation of undigested food eaten.
    5. Unpleasant putrid odor from the mouth. As a result of the presence of an obstruction in the esophagus, food is retained and accumulates in front of the obstruction.
    6. Weight loss. This is caused both by cancer intoxication and a decrease in appetite, and by the fact that the patient deliberately refuses to eat due to the fact that the process of eating causes him pain.

    Graduation by degrees

    There are 4 grades of cancer depending on its size and structure:

    1. Up to 3 cm. Only the mucous membrane is affected.
    2. 3 - 5 cm. Diagnosed with metastases localized in the lymphatic vessels.
    3. 5 - 8 cm. The tumor invades the entire thickness of the esophagus. Has metastases to lymph nodes.
    4. More than 8 cm. Grows into adjacent organs.

    Signs of cancer depend on its degree

    • At grade 1, the patient does not feel any tangible abnormalities, but cancer is already clearly detected on endoscopy of the esophagus.
    • At grade 2, the disease may still proceed without visible manifestations, but some already have disturbances in the process of swallowing.
    • At grade 3, all or almost all of the signs of cancer are already manifested - weight loss, impaired swallowing, pain.
    • At grade 4, the patient's condition is severe. All signs of cancer are expressed. A cancerous tumor can spread along the wall of the esophagus, and can grow into its lumen.

    Treatment and prognosis

    The surgical treatment of cancer patients is rather controversial. On the one hand, namely radical surgery gives an effective chance to prolong life. On the other hand, these operations are always complex, very traumatic. The patient needs a lot of strength for a long postoperative period. And these patients are always especially emaciated and exhausted by the disease.

    During surgery, the pathologically altered part of the esophagus is replaced by tissue from the stomach or intestines. In this case, both cavities open: chest and abdominal. This is a big load on the body. The postoperative period is long and requires patience and knowledge from the personnel.

    The operation is advisable only at stages 1 and 2, it is controversial at stage 3. The complexity of the operation also increases because the most vital organs are located nearby, which not only cannot be removed during tumor growth, but also extremely risky to damage.

    Radiation and chemotherapy are also used.

    The question of how long they live with such a pathology cannot be answered precisely. The fluctuations of this period are influenced by the patient's age, concomitant diseases, the time of visiting doctors and the level of therapy, metastases, invasion into other organs and the level of aggressiveness of the tumor. According to averaged data, only 10-15% of all patients survive the 5-year period.

    A favorable prognosis is possible only in stages 1 - 2.

    Grade 3 is already characterized by the presence of diagnosed metastases. The tumor has already captured all layers of the esophagus and has grown into nearby organs. The choice towards surgical intervention is possible when the patient is stable, which allows him to undergo surgery, a long postoperative nursing period, and also if he insists on the operation.

    This surgical intervention will have a wide localization. The affected part of the esophagus and lymph nodes are removed. With a successful outcome of the operation and the postoperative period, about 10% of patients live for another 5 years.

    If important neighboring organs are already affected by the tumor, then surgical intervention is inappropriate. In this case, only palliative symptomatic treatment is performed. Then the life expectancy will be up to a year. If no treatment was used, then the prognosis is very poor and the survival rate will be 6-8 months. From the moment the first symptoms appear, life expectancy is up to 5 years.

    Malignant formation of the esophagus progresses, relative to cancerous tumors of other localization, not very quickly. But given that cancer of this localization does not make itself felt for a long time and manifests itself as symptoms only at a rather late stage, its treatment is already ineffective.

    After surgery, chemotherapy and radiation therapy, the survival rate in patients with stage 1 is 90%, stage 2 - 50%, stage 3 - 10%.

    Ethnoscience.

    There are folk remedies that have anti-cancer effects. Believe them or not - everyone's business. Herbs of plantain, celandine, mint, meadowsweet, cartilage and others are used. It will be more rational to use herbal treatment as an adjuvant.

    Esophageal cancer is not a death sentence. With its timely identification and treatment, the prognosis can be favorable.

    Some more news:

    bolzheludka.ru

    Esophageal carcinoma

    Treatment goals: partial or complete resection of an organ with a malignant neoplasm.

    Treatment tactics

    Drug-free treatment

    Radical surgery (subtotal resection or extirpation of the esophagus with regional lymph node dissection) is the generally accepted standard in the treatment of patients with resectable esophageal cancer.

    Palliative operations also play an important role in the care system for this category of patients, and ensure the elimination of dysphagia as the most significant manifestation of the disease.

    In 80-90% of patients, malignant tumors of this localization are diagnosed in stages III-IV, and therefore only for 10-15% of patients radical surgical and combined treatment is possible.

    Postoperative radiation therapy in SOD 50 Gy is used in the case of non-radical removal of a tumor or tumor growth in the edge of the esophagus cut.

    Radiation therapy, polychemotherapy and chemoradiation therapy acquire an independent significance in the case of initial unresectability of esophageal carcinomas and in the presence of distant metastases, as well as contraindications to surgical treatment and refusal of the patient from surgery.

    Radiation and chemoradiation therapy as an independent method of treatment can be used for tumor localization in the cervical esophagus.

    Palliative operations (gastrostomy placement, esophageal stenting with nitinyl stents) are performed for health reasons in case of unresectability of the tumor process, in the presence of distant metastases, ineffectiveness of chemoradiation treatment, cachexia and the development of esophageal fistulas.

    Surgery

    Surgical treatment is the main method for resectable cancer of the esophagus with and without metastatic lesions of regional lymph nodes.

    Surgical treatment involves resection or extirpation of the esophagus with a deviation from the edges of the tumor more than 5 cm and the mandatory regional lymph node dissection.

    Age is not a contraindication to surgery.

    The volume of surgery is determined by the localization and extent of the tumor lesion and includes:

    Subtotal resection of the esophagus with posterior-mediastinal gastroesophagoplasty by abdominothoracic access with intrapleural anastomosis;

    Extirpation of the esophagus by thoracoabdominocervical access with posterior mediastinal gastroesophagoplasty or colonoesophagoplasty with anastomosis on the neck;

    Resection of the lower thoracic esophagus and proximal stomach from the combined left-sided thoracophrenolaparotomic approach (Osawa-Garlok) in the lower thoracic tumor localization with / without transition to the cardiac part of the stomach. If the intrathoracic esophagus is affected, regional lymph node dissection is indicated: removal of regional mediastinal and abdominal lymph nodes.

    With combined extirpation of the esophagus with resection of the trachea, main bronchi, aorta and other vital structures, delayed plastic surgery of the esophagus is possible after the formation of an esophago- and gastrostomy.

    Surgical interventions are accompanied by lymph node dissection, depending on the level of performance, they are divided: standard two-zone (2S), extended two-zone (2F) and three-zone lymph node dissection.

    Drug treatment (only funds registered in the Republic of Kazakhstan, INN, course or daily doses, indicating the form of release are indicated. Indicate pharmacological groups, ex: proton pump inhibitors. omeprazole, lansoprazole, rabeprazole. If there are any specific prescriptions, please indicate: insulin pump, etc.)

    If necessary, the treatment is prescribed in stages: emergency, outpatient, inpatient.

    Chemotherapy

    Chemotherapy is performed as part of neoadjuvant chemoradiation therapy followed by surgery, as part of chemoradiation therapy, or independently in case of initial unresectability of esophageal carcinomas and in the presence of distant metastases, as well as contraindications to surgical treatment (in the absence of contraindications to chemotherapy) and the patient's refusal of surgery

    Monochemotherapy:

    1. Paclitaxel 250 mg / m2, IV, 24-hour infusion, 1st day. Every 21 days. Colony-stimulating support is recommended.

    2. Cisplatin 20 mg / m2, from the 1st to the 5th day, every 3 weeks or 80 mg / m2, 1 p / 3 weeks.

    3. Bleomycin 10-15 mg / m2, 2 times a week, up to a total dose of 200-300 mg.

    4. Doxorubicin 40 mg / m2, 1st and 2nd days, every 3 weeks.

    5. Epirubicin 30 mg / m2, from the 1st to the 3rd days, every 3 weeks.

    6. Fluorouracil 500 mg / m2, from the 1st to the 5th day, every 5 weeks.

    7. Methotrexate * 40 mg / m2, weekly, long-term.

    8. Vinorelbine * 25 mg / m2, weekly, long-term.

    9. Mitomycin * 20 mg / m2, 1 p / 4-6 weeks.

    * methotrexate, bleomycin, vinorelbine in mono-mode is more often used as a second line of treatment.

    Combined chemotherapy:

    1. Cisplatin 75-100 mg / m2, intravenously, on the 1st day. Fluorouracil 1000 mg / m2, long-term, intravenous infusion, from the 1st to the 5th day. Repeat the course for 1, 5, 8 and 11 weeks.

    2. Irinotecan 65 mg / m2, IV, weekly for 4 weeks. Cisplatin 30 mg / m2, IV, weekly for 4 weeks. Repeat the course every 6 weeks.

    3. Paclitaxel 180 mg / m2, 3-hour infusion, 1st day. Cisplatin 60 mg / m2, 3-hour infusion, 1st day. Repeat every 2 weeks (maximum 6 courses) or paclitaxel 200 mg / m2, 24 hour infusion, day 1. Cisplatin 75 mg / m2, i.v., 2nd day. Repeat every 3 weeks *.

    4. Carboplatin AUC 5, 1st day. Paclitaxel 150 mg / m2, 3 hour infusion, day 1. Every 3 weeks.

    5. Paclitaxel 175 mg / m2, 1st day. Cisplatin 20 mg / m2, from the 1st to the 5th day. Fluorouracil 750 mg / m2, long-term, intravenous infusion, from the 1st to the 5th day. Every 28 days if necessary, against the background of primary prophylaxis with colony-stimulating factors.

    6. Docetaxel 75 mg / m2, 1st day. Cisplatin 75 mg / m2, 1st day. Every 3 weeks.

    7. Docetaxel 75 mg / m2, 1st day. Cisplatin 75 mg / m2, 1st day. Fluorouracil 750 mg / m2, long-term, intravenous infusion, from the 1st to the 5th day. Every 3 weeks, if necessary, against the background of primary prophylaxis with colony-stimulating factors.

    Other treatments

    Radiation and chemoradiation therapy

    Radiation and chemoradiation therapy as an independent method has no advantages over surgical treatment. Long-term survival in stages I – II can be achieved in only 25–30% of patients with complete tumor resorption. The positive point is the ability to avoid the risk of postoperative mortality and save the esophagus. However, it should be noted that post-radiation complications (esophagitis, ulcer, stricture, fistula) develop in 30-40% of cases and, as a rule, require surgical treatment.

    Radiation therapy technique

    External beam radiation therapy is carried out according to the method of conventional (standard) or conformal irradiation ROD 1.8-2.0-2.5 Gy 5 fractions per week up to SD 60-70 Gy in independent mode, SD 40-50 Gy in preoperative or postoperative mode ... A continuous or split course of radiation therapy is used. Irradiation is carried out on gamma therapy devices or linear accelerators.

    The primary focus is irradiated either only with external beam radiation therapy, or (with a relatively small primary tumor and the possibility of introducing endostats) - with the help of contact radiation therapy after a dose of external radiation therapy of 46-50 Gy to SD, isoequivalent to 70 Gy. The use of combined radiation therapy makes it possible to more than double the frequency of complete tumor resorption in comparison with external radiation therapy alone.

    The planned radiation volume includes the primary tumor plus 5 cm of normal tissue up and down from the tumor borders and 2 cm laterally. The regional lymph nodes of the first barrier (N1) are irradiated at the same dose as the tumor.

    When the tumor is localized in the cervical spine, the cervical and upper thoracic segments and all adjacent lymph nodes, including the supraclavicular, are irradiated.

    When the tumor is localized in the upper and / or middle thoracic regions, the entire thoracic segment up to the level of the diaphragm and mediastinal lymph nodes are exposed to radiation.

    When the tumor is localized in the lower thoracic region, the thoracic and abdominal segments below the level of the diaphragm, mediastinal and perigastric lymph nodes are exposed to radiation.

    The height of the irradiation fields varies from 11 to 22 cm, the width of the fields is 5–6 cm. A total of 4 radiation fields are used.

    Chemoradiation treatment includes external radiation therapy with a total absorbed dose of up to 50 Gy in a continuous course (suboptimal dose) with fractionation of 1.8–2 Gy. At the beginning and immediately after the completion of radiation therapy, courses of polychemotherapy are carried out according to the scheme "cisplatin + 5-fluorouracil", then, with an interval of 28 days, another 1-2 courses of polychemotherapy are carried out.

    Contraindications to external beam radiation therapy are: - presence or threat of development of esophageal fistulas; - decay of a tumor with signs of bleeding; - germination of the entire wall of the trachea, main bronchi and aorta;

    Decompensated comorbidities.

    If the patient refuses surgical treatment or if there are contraindications to surgery, a course of combined radiation therapy is indicated:

    Stage I - external beam radiation therapy in a suboptimal dose of 50 Gy, 2 Gy 5 times a week, in a continuous course for 5 weeks.

    Stage II - brachytherapy 3 weeks after external beam radiation therapy in 3 sessions of 5 Gy with an interval of 7 days. Calculation point (reference point) 1 cm from the center of the radioactive source.

    When planning a palliative course of radiation therapy for severe tumor stenosis, the course of combined radiation therapy can be started with brachytherapy sessions.

    To improve the effect, polychemotherapy is used:

    Cisplatin 75 mg / m2, IV, on day 1;

    Fluorouracil 1000 mg / m2 (750 mg / m2) IV; on the 1st, 2nd, 3rd, 4th days.

    General treatment regimen:

    Contraindications to brachytherapy:

    1. The extent of the tumor along the esophagus is more than 10 cm.

    2. The presence of distant metastases.

    3. The spread of the tumor to the trachea and main bronchi.

    4. Localization of the tumor in the cervical esophagus.

    5. Pronounced narrowing of the esophagus through which it is impossible to pass the endoscope.

    Treatment of esophageal cancer depending on the location and stage of the tumor process

    Stages Standard
    Cervical esophagus
    0, I, IIA

    Extirpation of the esophagus with posterior mediastinal gastroesophagoplasty or colonoesophagoplasty by cervicabdominotranschiatal access with an anastomosis on the neck, cervical lymphadenectomy.

    Chemoradiation treatment: radiation therapy in the mode of conventional fractionation SOD 50 Gy in a continuous course + 3-4 courses of polychemotherapy according to the scheme "cisplatin + 5-fluorouracil".
    IIB, III

    1. External beam radiation therapy SOD 60-65 Gy or combined radiation therapy at SOD 70-75 Gy.

    2. Polychemotherapy according to the scheme "cisplatin + 5-fluorouracil".
    Upper thoracic esophagus
    0, I, IIA, IIB, III 1. Extirpation of the esophagus with posterior mediastinal gastroesophagoplasty or colonoesophagoplasty by thoracoabdominocervical access with an anastomosis on the neck, mandatory abdominomediastinal lymphadenectomy.
    Middle and lower thoracic esophagus
    0, I, IIA, IIB, III

    1. Preoperative chemoradiation therapy (cisplatin + xeloda, cisplatin + taxotere + DLT SOD 50 Gy).

    2. Subtotal resection of the esophagus with posterior mediastinal gastroesophagoplasty by abdominothoracic access with intrapleural anastomosis, mandatory abdominomediastinal lymph node dissection.

    3. Postoperative radiation, chemoradiation therapy.
    For all parts of the esophagus
    IV, IVA, IVB

    1. External beam radiation therapy of SD up to 60 Gy or, if possible, combined radiation therapy in SD of 70-75 Gy.

    2. Polychemotherapy according to the scheme "cisplatin + 5-fluorouracil".

    3. Chemoradiation treatment: radiation therapy in the mode of conventional fractionation of SOD 50 Gy in a continuous course + 3-4 courses of polychemotherapy according to the scheme "cisplatin + 5-fluorouracil".

    4. Palliative gastrostomy, esophageal stenting.
    Refusal of surgical treatment and with contraindications to surgical treatment for all parts of the esophagus
    0 - III

    1. External beam radiation therapy SOD 60-65 Gy or combined radiation therapy at SOD 70-75 Gy.

    2. Polychemotherapy according to the scheme "cisplatin + 5-fluorouracil".

    3. Chemoradiation treatment: radiation therapy in the mode of conventional fractionation of SOD 50 Gy in a continuous course + 3-4 courses of polychemotherapy according to the scheme "cisplatin + 5-fluorouracil".

    4. For the intrathoracic esophagus. Combined radiation therapy: external beam therapy in the mode of conventional fractionation SOD 50 Gy in a continuous course + 3 brachytherapy sessions of 5 Gy + 4 courses of polychemotherapy according to the scheme "cisplatin + 5-fluorouracil", "cisplatin + taxotere", "cisplatin + xeloda".

    Preventive actions

    Balanced fortified food, exclusion of smoking and alcohol abuse.

    Hypovaminosis A and B2, accompanied by necrotizing ulcerative esophagitis; thermal, chemical, mechanical factors; smoking and alcohol abuse; positive family history

    Further management: after treatment, patients are monitored every three months during the first year and every 6 months for the next 2 years.

    Indicators of the effectiveness of treatment and the safety of diagnostic and treatment methods described in the protocol (for example: absence of signs of inflammation of the peritoneum, absence of postoperative complications, indicating diagnostic criteria for monitoring the effectiveness of treatment measures - for example: monitoring the state of hemoglobin (blood plasma glucose) levels and etc. - in the morning-evening every day, once a week, etc.)

    Satisfactory condition, provided that there are no complications and wound healing, no signs of malignant neoplasm.

    At each control, the following must be carried out: clinical examination, complete blood count, ultrasound examination of the abdominal organs and retroperitoneal space.

    X-ray examination of the chest organs and radiopaque examination of the esophagus are carried out 1 time in 6 months, the first 3 years, then - 1 time in 12 months.

    With appropriate indications, the patient is hospitalized and additional studies are performed: endoscopy, computed tomography, biopsy of peripheral lymph nodes, radioisotope study, PET study.

    diseases.medelement.com

    Diagnosis of esophageal cancer

    An oncological disease that affects the esophagus and constitutes a significant part of all pathologies of this organ is called esophageal cancer. The main clinical signs of this pathology are dysphagia (progressive violation of the act of swallowing) and sudden weight loss.

    Esophageal cancer is more common among men, the incidence of the disease among all types of cancer is 5-7%. ICD-10 code: cancer of the esophagus (C15 Malignant neoplasm of the esophagus).

    How to check the esophagus for cancer? This question worries many people who monitor their health. There are various diagnostic methods that can detect esophageal cancer.

    Early diagnosis of esophageal cancer

    Early diagnosis of esophageal cancer is limited. This is due to the fact that today there are no effective and reliable methods for this diagnosis. People with risk factors should have regular screening for esophageal cancer.

    In the presence of Barrett's esophagus, which is a precancerous condition, the patient should undergo biopsy and endoscopy procedures every few years, during which the most suspicious areas are taken from the esophageal mucosa for further examination.

    If cell dysplasia is found, then these examinations should become annual. With severe dysplasia, removal of part of the esophagus is indicated to prevent the development of a tumor. This tactic allows diagnosing esophageal cancer in the early stages when the prognosis of the disease is still favorable.

    Early signs of esophageal cancer

    Unfortunately, a pronounced clinical picture in esophageal cancer is usually observed only in the late stages of the disease, which greatly complicates the diagnosis of cancer. Common symptoms that can be seen with esophageal cancer are:

    • general weakness, decreased performance;
    • increased fatigue, irritability;
    • increased body temperature;
    • anemia;
    • sharp weight loss.

    The main symptom of esophageal cancer is dysphagia, which initially manifests itself as a feeling of awkwardness when swallowing food, a feeling of food "sticking" to the walls of the esophagus. Over time, these symptoms worsen, there is a violation of the patency of the esophagus.

    Another symptom that is characteristic of late stages of esophageal cancer is pain that occurs both with food intake and on its own. Painful sensations can be periodic or constant and are explained by the fact that the tumor grows, erosions appear on its surface and esophagitis develops.

    If pain begins to appear in the area between the shoulder blades, then this may be a sign that the tumor has gone beyond the esophagus.

    Often people take such pains for manifestations of osteochondrosis or heart disease and are engaged in appropriate treatment, and at this time the tumor continues to grow and by the time it is detected, the person can no longer be helped.

    When a neoplasm grows into the respiratory tract (bronchi or trachea), the patient develops a painful, painful cough with blood, and the temperature rises. As a result of tumor growth, internal bleeding and pericarditis may develop.

    When metastases appear in distant organs, the most characteristic symptom is severe pain.

    Diagnostic tests for suspected esophageal cancer

    In addition to the clinical signs of the disease, which usually appear in the late stages, there are a number of instrumental and laboratory methods for diagnosing esophageal cancer:

    X-ray of the esophagus. It is performed using X-ray contrast agents, since the esophagus is not visible on a regular image. Most often, a suspension of barium is used for this purpose, which, passing through the esophagus and stomach, fills their contours. The image shows filling defects, and the presence of a tumor is determined from them.

    Study of biological material obtained from a biopsy. The absence or presence of cancer cells and the type of tumor are revealed.

    EFGDS (esophagogastroduodenoscopy). It is carried out using a special device - an endoscope. The procedure allows you to assess the state of the gastrointestinal tract (including the esophagus) and conduct early diagnosis of cancer, as well as take material for subsequent microscopic examination.

    Identification of tumor markers in the blood. It is known that tumor cells secrete special substances by which the presence of cancer can be determined. Tumor markers for esophageal cancer: TPA, SCC, CYFRA 21-1. It should be remembered that the number of tumor markers increases sharply in the late stages of cancer, in the initial stage of the disease they are detected in less than 50% of patients.

    Bronchoscopy. It is carried out to determine the state of the upper respiratory organs (trachea, larynx, bronchi).

    Ultrasound. In the study, a special sensor is used, which is inserted into the esophageal cavity. Using this method, you can estimate the size of the tumor and determine if there are metastases in nearby lymph nodes.

    CT scan. This is a highly effective diagnostic method, with the help of which it is possible to detect a tumor with a size of 1 millimeter, and also to reveal the presence of metastases.

    Optical coherence endoscopic tomography. This is a relatively new method for diagnosing esophageal cancer. As a result of the study, it is possible to examine the structure of the affected tissues at a depth of 2 millimeters, which makes it possible to abandon the more dangerous and painful biopsy procedure.

    Positron emission tomography. Before carrying out this study, the patient is injected with radioactive glucose, which has the property of accumulating in cancer cells. Then, with the help of a special scanner, pictures are taken in which you can see all malignant formations ranging in size from 5 to 10 millimeters.

    A blood test for esophageal cancer in the early phases of the disease is ineffective.

    In the later stages, there is an increased ESR, a decreased number of eosinophils, a shift in the leukocyte formula to the left, and hypochromic anemia.

    The gastroenterologist is engaged in the treatment of diseases of the esophagus and stomach. If you want to find the best gastroenterologist in your city, use the doctor ratings based on patient reviews.

    Select the city of residence.

    Gastric polyps are neoplasms that protrude above the surface of the mucous membrane of a given digestive organ. The symptomatology of such formations is not specific, which complicates the diagnosis.

    According to ICD 10, the growths in the stomach cavity belong to the tenth revision of the morphology of such neoplasms. The lesions are benign tumor-like formations with a glandular structure that comes from the mucous membrane.

    The danger of the disease lies in the fact that it proceeds without pronounced symptoms. At an early stage, pathology is rarely found.

    If such neoplasms reach an impressive size, there is a risk of developing cramping pain syndrome in the abdomen, gastric bleeding, as well as a difficult evacuation of the food lump from the stomach cavity.

    In some situations, malignancy occurs. Endoscopic biopsy, fibrogastroscopy, and radiography of the gastric cavity are used as the basis for diagnosis.

    With regard to treatment, tactics, as a rule, have a wait-and-see nature, or surgery is immediately prescribed.

    Etiology and classification

    The human stomach is made up of three layers, outer, inner, and muscular. Sometimes, for some reason, uncontrolled cell growth in the inner layer can be observed. The resulting growth answers the question "what are polyps in the stomach."

    Description of pathology

    Typically, these growths are benign clumps of cells that form on the wall inside the stomach. Pathology got its name from the Greeks, “poli” means “many”, “pus” means “leg”. Indeed, polyps in the stomach with a base can attach to a small leg, resembling a mushroom or a berry in shape.

    Pathology is rare. If there is a suspicion of polyps in the stomach - what determines this disease most accurately? Unfortunately, it is very difficult to recognize it by symptoms.

    The presence of polyps can be accompanied by some unpleasant sensations, possibly bleeding, but most often the detection of growths is accidental. It can occur during the examination of a patient on suspicion of another disease.

    Polyps according to ICD10

    The International Classification of Diseases - ICD 10 - is a constantly updated list of diseases, each of which is assigned a specific code. With its help, a record is kept of diseases, the reasons for which the client was referred to a medical institution, the reasons for death.

    The list also includes a polyp of the stomach, microbial 10 takes into account and describes this pathology as "polyp of the stomach and duodenum 12". The polyp of the stomach has a code for μb 10 K31.7, with the exception of an adenomatous polyp passing under the code D13.1.

    Stomach polyps - are they dangerous

    Diagnosis of esophageal cancer

    An oncological disease that affects the esophagus and constitutes a significant part of all pathologies of this organ is called esophageal cancer. The main clinical signs of this pathology are dysphagia (progressive violation of the act of swallowing) and sudden weight loss.

    Esophageal cancer is more common among men, the incidence of the disease among all types of cancer is 5-7%. ICD-10 code: cancer of the esophagus (C15 Malignant neoplasm of the esophagus).

    How to check the esophagus for cancer? This question worries many people who monitor their health. There are various diagnostic methods that can detect esophageal cancer.

    Early diagnosis of esophageal cancer

    Early diagnosis of esophageal cancer is limited. This is due to the fact that today there are no effective and reliable methods for this diagnosis. People with risk factors should have regular screening for esophageal cancer.

    In the presence of Barrett's esophagus, which is a precancerous condition, the patient should undergo biopsy and endoscopy procedures every few years, during which the most suspicious areas are taken from the esophageal mucosa for further examination.

    If cell dysplasia is found, then these examinations should become annual. With severe dysplasia, removal of part of the esophagus is indicated to prevent the development of a tumor. This tactic allows diagnosing esophageal cancer in the early stages when the prognosis of the disease is still favorable.

    Early signs of esophageal cancer

    Unfortunately, a pronounced clinical picture in esophageal cancer is usually observed only in the late stages of the disease, which greatly complicates the diagnosis of cancer. Common symptoms that can be seen with esophageal cancer are:

    • general weakness, decreased performance;
    • increased fatigue, irritability;
    • increased body temperature;
    • anemia;
    • sharp weight loss.

    Polyps in the stomach symptoms and treatment

    Treatment. The choice of treatment method depends on the stage of the disease and the location of the tumor.

    Radical operations - extirpation of the esophagus according to Osawa-Garlock, Lewis. In severe, debilitated patients, the Dobromyslov-Torek operation is performed.

    The indications for extensive combined resections are now expanding. Preoperative radiation and chemotherapy are used to increase resectability.

    The operation is performed in 4–6 weeks. Radiation therapy as an independent method is indicated for lesions in the proximal part of the middle third or in the upper third of the esophagus and the impossibility of performing the operation (or the patient's refusal).

    The total focal dose is approximately 60 Gy. Chemotherapy has practically no effect on the life expectancy of patients.

    Forecast. After radical surgical treatment, the 5-year survival rate for all groups of patients is 5-15%. In patients operated on in the early stages of the disease (without visible damage to the lymph nodes), this figure rises to 30%.

    Have questions?

    Report a typo

    Text to be sent to our editors:

    Send message