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1、Carcinoma of Esophagus,Speaker:LiuRan,1,肠道相关,Content,Anatomy of the Esophagus Summary Pathogeny(发病机制) Clinical feature Diagnose Differential diagnosis Exercise,2,肠道相关,Anatomy of the Esophagus,The esophagus is a muscular tube, which is a digestive organ between the throat and stomach.,3,肠道相关,Physiolo
2、gical stenosis of esophagus,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).,4,肠道相关,3 Sections of the esophagus,The upper segment The middle segment （Carcinoma occur most frequent） The lower segment,Tracheal
3、bifurcation (气管分叉),5,肠道相关,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).,6,肠道相关,Prevalence and mortality,There are more than 300,000 people worldwide died from esophageal cancer each year , and 150,0
4、00 of them are Chinese.,7,肠道相关,Pathogeny,1. Nitrosamine(亚硝胺) 2. Fungus(真菌) 3. Vitamin deficiency 4. Dietary habits,8,肠道相关,Nitrosamine,Nitrosaminescontent of thesefoodsare very high,9,肠道相关,Clinical feature,In early stage Symptoms are often not obvious, but when swallowing the coarse food ,different d
5、egrees of uncomfortable feelings may occur.,10,肠道相关,Clinical feature,In the middle and advanced stage Progressivedysphagia (进行性吞咽困难) When the tumorinvadethe trachea , tracheoesophageal fistula(气管食管瘘) Cachexia(恶病质),11,肠道相关,Classification of esophagealcancer,1. Ulcerative type(溃疡型) 2. Mushroom type(蕈伞
6、型) 3. Constrictive type(缩窄型) 4. Medullary type(髓质型),12,肠道相关,Diagnose,1. X-raybariummeal 2. Computed Tomography(CT) 3. Magnetic Resonance Imaging(MR),13,肠道相关,1. X-raybariummeal,(1). Early stage Esophagealmucosal folds be beak(粘膜迂曲、断裂) Single ormultiple smallniches(龛影) Limiting filling defect(局限性充盈缺损)
7、 Barium streamslow ortemporaryresidence(钡剂流动缓慢或一过性滞留),14,肠道相关,Postoperation Recur,15,肠道相关,Smallnodules(小结节),16,肠道相关,protrude type(隆起型),17,肠道相关,Earlyulcerative type,18,肠道相关,Early constrictive type,19,肠道相关,(2). Middle and advanced stage,a. Ulcerative type(溃疡型) niche,The surrounding of the tumor become
8、 bulged , and the folds of mucous become damaged. (周围隆起,粘膜皱襞破坏),20,肠道相关,Filling defect An expand over the tumor,b .Mushroom type,21,肠道相关,c . Constrictive type,M,63Y, Progressivedysphagia20d,22,肠道相关,d. Medullary type,广泛侵犯食管全层,形成腔外肿物，管腔狭窄，表面可见溃疡,The carcinoma can encroach on the whole-layer of esophag
9、us and make a stenosis,with ulceration on it.,23,肠道相关,2. CT,1. Esophagealwall circular or irregular thickening(5mm). 2. Cavity lump occurred. 3. Paraesophagealfat layerfuzzy,disappear. 4. Peripheralorgan got involvedorlymph node metastasis. 5. Enhanced scanning showedmild enhancement oftumor.,24,肠道相
10、关,25,肠道相关,Enhanced scanning,26,肠道相关,3. MR,There is a synechia(黏连) between the cancer and the aortic arch.,The high signal fat layer exist.,27,肠道相关,Cancer invade the trachea,T2WI：The fat layer disappeared and the wall of trachea be damaged.,T1W enhance scanning shows a lump in the trachea and be enha
11、nced like the carcinoma.,28,肠道相关,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).,29,肠道相关,1. Achalasia of cardia and esophagus,Intermittentdysphagia(间歇性吞咽困难) On a widened upper segment with fluid level Lower es
12、ophagus become thin like a beak(鸟嘴征) Without mucosal fold break.,30,肠道相关,31,肠道相关,2. Esophageal varices,Have a history of liver cirrhosis, portal hypertension. Beadedfilling defect(串珠样充盈缺损) Enhanced CT scanshowed vascular tortuositygroup remarkable enhancement and delayedenhancement. Barium emptying
13、delay, but no obstruction phenomenon.,32,肠道相关,33,肠道相关,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.,34,肠道相关,35,肠道相关,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.,36,肠道相关,Ulcerative carcinoma,37,肠道相关,The end,Thank you!,38,肠道相关,
