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1、Carcinoma of the Esophagus and CardiaSegmentationCervicalUpper thoracic Middle thoracicLower thoracicAnatomic narrowing pharyngoesophageal sphincterleft main stem bronchus e s o p h a g e a l hiatus of the diaphragmHistologyMucosaSubmucosaMuscularis proximal 5%striated,distal 54-62%smoothAdventitia
2、Epidermiology:China,middle Asia,north Africa,in some regions of France,Caribbean basin LinXian has the highest incidence 150/100,000.Etiology Ingestion of nitrosamines，mouldy food Genetic factors Malnutrition and deficiency of trace elements Dietary habitats(smoking and alcohol)Other predisposing di
3、sease Gross Classification Early stage:occultplague likeerosivepapillaryAdvanced stage medullar(60%)fungating ulcerative constrictive intralumial Pathological classificationSquamous cell carcinomas 95%AdenocarcinomasUndifferentiatedClinical PresentationClinical Presentationdyspagiaretrosternal burni
4、ng odynophagiafeeling of foreign bodyClinical Presentationweight losschest pain contiguous structure invasion hoarseness,cough,tracheobronchial fistula,hematemesis,melenaDiagnosisBarium EsophagramEarly stage:irregularity of mucosa,small filling defection,small crater,stiffness of wallLate stage:ragg
5、ed mucosa,irregular filling defect and crater,luminal narrowing,dilatation CTRadionuclide scanning TNM Staging International Union Against Cancer(UICC)Primary Tumor(T)Regional Lymph Nodes(N)Distant Metastasis(M)Differential Diagnosis1Esophagitis2Corrosive stricture3Benign tumor(Leiomyoma)4Diverticul
6、um5Varicose6Achalasia of cardiaTreatmentSurgical procedureRadiotherapyChemotherapyImmunotherapyChinese medicineSurgeryIndication good general status no distant metastasis resectable no hoarseness or severe chest pain SurgeryContraindication poor cardiopulmonary reservationcachexiaunresectable&distal
7、 metastasisSurgical Procedure esophagectomy+esophagogastrostomy interposition of jejunum interposition of colon SurgeryComplications Anastamosis leak chylothorax Surgical ResultsResection rate:56.3%-92.9%5 year survival rate(mean):18.1%40.8%5 year survival rate(early stage):90%Radiotherapy and Chemo
8、therapyRadiotherapycervical and upper thoracic non-surgical candidateunresectableChemotherapy poor sensitivity,adjunctive therapyPalliative therapyLaser,self-expanding metal stents,bougienage Disorders of MediastinumQing Ye,M.D.Dept of Cardiothoracic SurgeryRenji HospitalAnatomy Borders Subdivision
9、anterior mediastinum middle mediastinum posterior mediastinumLocation of Tumors and Cysts Anterior(54%)teratomas,teratodermoidcyst,lymphomas,thymic neoplasms,intrathoracic goiter Middle(20%)tracheal and brochogenic cysts,pericardial cyst,lymphomas Posterior(26%)neurogenic tumors(neurofibroma,neurile
10、moma,ganglioncytoma)Symptoms and Diagnosis Asymptomatic Nonspecific manifestation:weight loss,fever,fatigue,night sweets Local compression chest pain,dyspnea,cough,dysphagia,superior vena caval syndrome Systemic effects hormones and antibodies(myasthenia gravis)Diagnosis chest films,CT,MRITeratomas
11、and TeratodermoidcystPathology Teratoma:solid,contains well-differentiated multiple tissue elements from the three primitive embryonic layers Teratodermoid cyst:composed predominantly of derivatives of the epidermal layer Clinical presentation chest pain cough dyspnea recurrent pneumonitis cough pro
12、ductive of hair or sebaceous materialDiagnosis x-ray manifestations fatty mass unilobular or multilobular globular clacification,bone,or well-formed teeth and a solid protuberance into a cystic cavity Therapysurgical excisionw/wo the adjunctive use of radiation therapy,chemotherapy ThymomaPeak incid
13、ence:20-50 yrsHistologically classificationEpithelial,lymphocytic,mixed,and spindleMalignancy:capsular invasionSymptomsLocal mass effects:chest pain,dyspnea,hemoptysis,cough,and superior vena caval syndrome,hoarseness,Systemic:myasthenia gravis,aplastic anemis,Cushings syndrom,hypogammaglobulinemia,
14、systemic lupus erythematosus,ThymomaX-ray appearance small,well-circumscribed mass or a bulky lobulated mass Therapy:thymectomy w/wo the adjunctive use of radiation therapy,chemotherapy Myasthenia Gravis Myasthenia gravis occurs in 10-15%of patients with thymoma 80%of Myasthenia gravis patients with
15、 thymomaEtioloyDestruction of postsynaptic nicotinic acetylcholine receptorsautoimmune process antiacetylcholine receptor Ab in high titers Thymic lymphocytes produce Ab immunoglobulin(Ig)G induce MGTherapyMedical treatment anticholinesterase agents corticosteroids plasmapheresis Surgery Thymectomy(effectiveness 80-90%)Thank you
外科學教學課件：Carcinoma of the Esophagus and Cardia
