Predisposing Factors:

- Male
- 6th- 7th decades of life
- Family history of cancer

GERD and Barrets

Esophagus
GERD causes
metaplasia (Barrets
Esophagus)
Stratified squamous
epithelium that normally
lines the distal
esophagus is replaced by
columnar epithelium

Precipitating Factors:
- Tobacco Smoking
- Alcohol Intake
- Gastroesophageal Reflux
Disease with its resultant
Barrets Esophagus
- Caustic Injuries
- Drinking scalding-hot
liquids
- Obesity
- High fat and cholesterol
diet

Patient:
Smoker
Alcoholic

Alcohol Intake

Tobacco Smoking

Exposure to carcinogens
such as polycyclic
aromatic hydrocarbons,
nitrosamines and
acetaldehyde

Ingestion of ethanol
Converted to
acetaldehyde (it is
carcinogenic) by alcohol
dehydrogenase (ADH)
enzymes
Point mutations in
human lymphocytes,
sister chromatic changes
and cellular proliferation

Becomes dysplastic
Inhibits DNA repair;
DNA mutations;
Genetic alterations;
Activates protooncogenes and/or
disable tumor
suppressor genes

Acetaldehyde is
detoxified to acetate by
acetaldehyde
dehydrogenase (ALDH)

ESOPHAGEAL SQUAMOUS CARCINOMA

-

Chest X-ray: Blunted right costophrenic angle;

Consolidation of right basal parenchyma
Endoscopic Findings: Vague stenotic lesion at
distal third; mucosa is edematous and redundant
Histopatholic Findings: Moderately differentiate
squamous cell carcinoma
Barium Swalllow: Constricting bands at distal 3rd
of esophagus with 90% narrowing, irregular
mucosal outline; dilated proximal body before the
lesion

Dysphagia,
regurgitation,
cough, weightloss

Risk Factors
Pathophysiology
Signs/Symptoms/Labs/Diagnostics
Patients Case

VII. THERAPEUTIC MANAGEMENT

LIST OF PROBLEMS
1. Dysphagia
2. Heartburn
3. Malnutrition:
- Regurgitation
-Weightloss
ADVICE AND INFORMATION

THERAPEUTIC OBJECTIVES
1. To identify and treat underlying cause of the
disease
2. To return the vital sign parameters to normal
3. To restore/improve body strength
4. To prevent complications
NON-PHARMACOLOGIC MANAGEMENT

Intra-Operative (Surgical Management):

Treatment of esophageal cancer varies by disease stage.
In our patients case, the esophageal squamous cell
carcinoma staging is Stage IA T1bN0M0. In patients with
T1b and any N, surgery may be the initial treatment.

An esophagectomy can be performed by using an

abdominal and a right thoracic incision transthoracic
esophagectomy [TTE]. Distal esophagectomy with lymph
node dissection is done.
For TTE, after exploring the peritoneal cavity for
metastatic disease (if metastases are found, the operation
is not continued), the stomach is mobilized. The right
gastric and the right gastroepiploic arteries are preserved,
while the short gastric vessels and the left gastric artery
are divided.
Next, the gastroesophageal junction is mobilized, and the
esophageal hiatus is enlarged. A pyloromyotomy is
performed, and a feeding jejunostomy is placed for
postoperative nutritional support.
After closure of the abdominal incision, the patient is
repositioned in the left lateral decubitus position and a
right posterolateral thoracotomy is performed in the
fifth intercostal space.
The azygos vein is divided to allow full mobilization of the
esophagus. The stomach is delivered into the chest
through the hiatus and is then divided approximately 5 cm
below the gastroesophageal junction.
An anastomosis (hand-sewn or stapled) is performed
between the esophagus and the stomach at the apex of
the right chest cavity. Then, the chest incision is closed.