食管癌(英文版)

CarcinomaofEsophagusSpeaker:LiuRanContent•AnatomyoftheEsophagus•Summary•Pathogeny(发病机制)•Clinicalfeature•Diagnose•Differentialdiagnosis•ExerciseAnatomyoftheEsophagus•Theesophagusisamusculartube,whichisadigestiveorganbetweenthethroatandstomach.Physiologicalstenosisofesophagus•First:Thejunctionofthepharynx(咽)andesophagus.•Second:locatedinthebackofleftprincipalbronchus.•Third:Esophagealhiatus(食管裂孔).3Sectionsoftheesophagus•Theuppersegment•Themiddlesegment（Carcinomaoccurmostfrequent）•ThelowersegmentTrachealbifurcation(气管分叉)Summary•Carcinomaoftheesophagusisacommonmalignanttumorthatoccursinapopulationcover40yearsold,andinpredilectionformale(好发于男性).Prevalenceandmortality•Therearemorethan300,000peopleworldwidediedfromesophagealcancereachyear,and150,000ofthemareChinese.Pathogeny•1.Nitrosamine(亚硝胺)•2.Fungus(真菌)•3.Vitamindeficiency•4.DietaryhabitsClinicalfeature•InearlystageSymptomsareoftennotobvious,butwhenswallowingthecoarsefood,differentdegreesofuncomfortablefeelingsmayoccur.ClinicalfeatureInthemiddleandadvancedstageProgressivedysphagia(进行性吞咽困难)Whenthetumorinvadethetrachea,tracheoesophagealfistula(气管食管瘘)Cachexia(恶病质)Classificationofesophagealcancer•1.Ulcerativetype(溃疡型)•2.Mushroomtype(蕈伞型)•3.Constrictivetype(缩窄型)•4.Medullarytype(髓质型)Diagnose•1.X-raybariummeal•2.ComputedTomography(CT)•3.MagneticResonanceImaging(MR)1.X-raybariummeal•(1).EarlystageEsophagealmucosalfoldsbebeak(粘膜迂曲、断裂)Singleormultiplesmallniches(龛影)Limitingfillingdefect(局限性充盈缺损)Bariumstreamslowortemporaryresidence(钡剂流动缓慢或一过性滞留)PostoperationRecurSmallnodules(小结节)protrudetype(隆起型)EarlyulcerativetypeEarlyconstrictivetype(2).Middleandadvancedstage•a.Ulcerativetype(溃疡型)••niche•Thesurroundingofthetumorbecomebulged,andthefoldsofmucousbecomedamaged.(周围隆起,粘膜皱襞破坏)FillingdefectAnexpandoverthetumorb.Mushroomtype•c.ConstrictivetypeM,63Y,Progressivedysphagia20d•d.Medullarytype广泛侵犯食管全层,形成腔外肿物，管腔狭窄，表面可见溃疡Thecarcinomacanencroachonthewhole-layerofesophagusandmakeastenosis,withulcerationonit.2.CT•1.Esophagealwallcircularorirregularthickening(5mm).•2.Cavitylumpoccurred.•3.Paraesophagealfatlayerfuzzy,disappear.•4.Peripheralorgangotinvolvedorlymphnodemetastasis.•5.Enhancedscanningshowedmildenhancementoftumor.Enhancedscanning3.MRThereisasynechia(黏连)betweenthecancerandtheaorticarch.Thehighsignalfatlayerexist.CancerinvadethetracheaT2WI：Thefatlayerdisappearedandthewalloftracheabedamaged.T1Wenhancescanningshowsalumpinthetracheaandbeenhancedlikethecarcinoma.Differentialdiagnosis•1.Achalasiaofcardiaandesophagus(食管贲门失弛缓征)•2.Esophagealvarices(食管静脉曲张)•3.Leiomyomaoftheesophagus(食道平滑肌瘤).1.Achalasiaofcardiaandesophagus•Intermittentdysphagia(间歇性吞咽困难)•Onawideneduppersegmentwithfluidlevel•Loweresophagusbecomethinlikeabeak(鸟嘴征)•Withoutmucosalfoldbreak.2.Esophagealvarices•Haveahistoryoflivercirrhosis,portalhypertension.•Beadedfillingdefect(串珠样充盈缺损)•EnhancedCTscanshowedvasculartortuositygroupremarkableenhancementanddelayedenhancement.•Bariumemptyingdelay,butnoobstructionphenomenon.3.Leiomyomaoftheesophagus(食管平滑肌瘤)•Smoothcircularcavityfillingdefectwithoutmucosalfoldbreakandsurroundingtissueinvasionandmetastasis.Exercise•1.Canurememberthe3physiologicalstenosisofesophagus?(InthisquestionucanansweritinChinese)•2.Pleaseshowusthefourtypesofthecarcinomaofesophagus.•3.Tellmewhichesophagusdiseaseitisinthefollowingpictures.UlcerativecarcinomaTheend•Thankyou!