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What is a straight collapsible 10 in tube that functions as a passageway thru the thorax
The Esophagus begins at the base of the ____ at the level of ___ and descends behind the trachea thru the ____
The esophagus penetrates the diaphragm thru an opening, the ___, and is continuous with the stomach on the abdominal side of the diaphragm
Where is the esophagus in close proximity to?
Aorta and Trachea
THe cervial esophagus is about ___ ling and extends from the level of ___ to the level of ___
Esophagus can be broken up into cervical and thoracic but also into
- Upper 3rd
- middle 3rd
- lower 3rd
Where are the esophageal cancers least and most common?
- Least in the upper 3rd
- Most in the middle or lower 3rd
Drainage of the esophageal lymphatics is unpredictable and can skip met. A distance of as much as ____ of normal esophagus may be interposed between site of tumor and lymphatic met
Which nodes are most important in esophageal cancers
What % of all cancers are esophageal?
What % of all cancerl deaths are esophageal?
Men are how many more times likely to get esophageal CA than women?
3-4 more times
African American are ____ higher risk than whites for esophageal CA
What is the age of diagnosis for esophageal CA
What are some incidences and etiology of esophageal CA
- Barrett's Esophagus
The distal part of the esophagus is lined with ____ instead of ____ like the beginning.
- columnar epithelium
- stratified squamous
What is a disease of the muscle of the esophagus in which the lower 2/3 loses normal peristaltic activity?
What is a disease that is in response to chronic GERD and changes the lining consistency of the esophagus
What is an iron deficient anemai that causes a difficulty in swallowing
Plummer vinson syndrome
what are some clinical presentations of esophageal CA
- #1 dysphagia and weight loss
- chest pain
- hematoemesis (vomitting blood)
- hemoptysis (spitting up blood)
What are ways to detect esophageal CA
- chest xray
What % of esophageal CA is located in the middle 3rd?
40-50% #1 spot
What % of esophageal CA is located in the upper 3rd?
10-25 % least common
What % of esophageal CA is located in the lower 3rd
What is the most common pathology for esophageal CA
Squamous cell (upper and middle)
What is the cancer called if found in this distal part or lower 3rd of the esophagus near the GE junction?
What is the staging for esophageal ca
TNM and based on outward extension
What is the 5 year survival rate for esophageal ca
Once esophageal CA is in the ____ it can skip around via lymphatics
Where are distant esophageal mets found
- #1 LIVER
How can esophageal ca spread?
- local invasion (trachesophageal, bronchoesophageal)
Where can surgery be done for esophageal ca
middle and lower 3rd and only for small non-mets
What are the complications for esophageal CA
- anastomic leaks
- myocardial infarction
- GE reflux
Which chemo durgs are used for esophageal ca
- 5-FU, cisplatin
- used in conjunction with radiation for better local control and distant met disease
what margin do you use to treat esophageal CA with radiation
- 5cm superior and inferior
- 2-3 cm laterally
If you have a lesion in your esophagus of the lower 3rd, how would you treat?
Treat with fields to include the mediastinal nodes and celiac axis
If you have a lesion in your esophagus of the upper 3rd, how would you treat?
A field that begins at the level of the thyroid cartilage and ends at the level of the carina to include the SCV nodes, low anterior cervial, and mediastinal nodes.
If you have a lesion in your esophagus of the middle 3rd, how would you treat?
- treat to include
- perisophageal modes
- mediastinal nodes
Which fields are used to treat the bulk of the esophageal tumor?
Which boost fields are done to treat esophageal ca
- a 3-field technique- AP and 2 posterior obliques, or
- olbiques, laterals or IMRT
How should you position a patient for treatment of esophageal ca
- Supine with arms overhead or by side
- prone with arms over head
When treating esophageal CA using radiation with chemo, what dose do you use?
5040 cGy with off cord at 3600-4500 cGy
If using radiation alone to treat esophageal CA, what dose do you use?
6500 cGy with off cord at 3600-4500 cGy
What critical structures do you worry about when treating with radiation for esophageal ca
What are the side effects for radiating esophageal ca
- #1 ESOPHAGITIS
- decreased blood counts
- radiation pneumonitis
- transvers myelitis