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What is Barrett’s Esophagus?
Metaplasia of esophageal squamous epithelium into columnar in distalQ esophagus
Risk factors for adenocarcinoma esophagus?
- • GERD (leading to Barrett’s esophagusQ)
- • ObesityQ
- • SclerodermaQ
Risk factors for squamous cell carcinoma esophagus?
- • AlcoholQ
- • SmokingQ
- • Ingested carcinogens
- • Plummer vinson syndrome
H. Pylori and carcinoma esophagus?
CAG-A positive strain is protective for adenocarcinoma esophagus but can lead to SCC of esophagusQ
MC esophageal cancer worldwide?
Squamous cell carcinomaQ
MC esophageal cancer in United States (Western countries)?
MC site of CA esophagus?
- Middle 1/3rd (Overall)Q
- SCC – Middle one third
- Adenocarcinoma – lower one third
Treatment of squamous and adenocarcinoma?
- Squamous cell - Treated aggressively with nonsurgical therapyQ
- Adenocarcinoma - Treated by a more aggressive surgical approachQ.
MC symptom of carcinoma esophagus?
Dysphagia >Weight lossQ
Diagnosis of carcinoma esophagus?
- • Barium swallow: First investigation doneQ in suspected case of CA esophagus (classic finding of an apple core lesionQ)
- • Endoscopy with biopsy: Investigation of choice for diagnosis of CA esophagusQ.
- • Endoscopic Ultrasound: Investigation of choice for staging of CA esophagus, best for T staging and LN metastasisQ.
- • CECT (abdomen and chest): metastasis to liver and lungsQ
SiewertQ classification GE junction tumors?
- Type I – within 1-5 cm above from GE junction
- Type II – from 1 cm above, 2 cm below GE junction
- Type III – From 2-5 cm caudal to GE junction
Features of Malignant Lymph Nodes on EUS?
- • Echo-poor (hypoechoic)Q structure
- • Sharply demarcated bordersQ
- • Rounded contourQ
- • Size >1 cmQ
Palliation Therapy in Carcinoma Esophagus?
- • Laser TherapyQ
- • Photodynamic TherapyQ
- • Radiation TherapyQ
- • SEMSQ (Self expandable metallic stent)
Features of CA Esophagus on Barium Swallow?
- • Mucosal irregularity and shoulderingQ
- • NarrowingQ of the lumen
- • Irregular “rat-tail” filling defectQ of the distal esophagus with shouldered edgeQ
- • Annular strictureQ
- • Sharp and clear cut edge of filling defectQ
- • Proximal dilatationQ of the esophagus
Best conduit after esophagectomy (overall)?
Conduit of choice after esophagectomy in CA esophagus?
Conduit of choice after esophagectomy in benign disorders (caustic injuries, acid-peptic disease), unhealthy stomach?
Conduit of choice for short segment replacement?
Gastric conduit is based on which vessel?
Right gastric and right gastroepiploic vesselsQ
Left colon is based on which vessel?
Left colic artery (Branch of IMA), placed in isoperistaltic direction.
What is Orringer Transhiatal Esophagectomy?
- • Double incision: Midline laparotomy followed by cervical incisionQ
- • Cervical anastomosis is doneQ
- • MC procedure done for carcinoma esophagusQ
What is Ivor-Lewis procedure?
- • Transthoracic esophagectomyQ
- • Double incision: Midline laparotomy followed by right sided thoracotomyQ
- • Done for tumors of middle 1/3rd of esophagusQ
What is McKeon procedure?
- • En-bloc esophagectomyQ
- • Three incisions: Right sided thoracotomy, followed by midlineQ laparotomy, followed by cervical incisionQ
- • Associated with maximum morbidity and mortalityQ
Tumor Margin for Curative Excision?
- In GI malignancies (stomachQ, small intestineQ, colonQ and proximal rectumQ), tumor margin for curative excision is 5cmQ except:
- − Esophagus: 10 cmQ
- − Distal rectum: 2 cmQ
Complications of Esophagectomy?
- • Anastomotic Leak (MC)Q
- • Anastomotic stricture
- • Pulmonary complications
- • Recurrent laryngeal nerve palsy
- • Chylothorax
MC benign esophageal tumorQ?