Risk factors and types of esophageal carcinoma

1. RISK FACTORS AND
TYPES OF
ESOPHAGEAL
CARCINOMA
Prepared by: Anish Dhakal (Aryan)
MBBS Student
Patan Academy of Health Sciences

2. OBJECTIVES
• To describe the risk factors of esophageal carcinomas
• To describe the progression of chronic acid reflux to
adenocarcinoma
• Highlight major aspects of squamous cell carcinoma

3. RISK FACTORS

4. • Plummer-Vinson syndrome
• Achalasia
• Hot beverages
• Hiatal hernia
• H.pylori can decrease
adenocarcinoma due
to gastric atrophy!
• Esophagal injury(e.g.lye
ingestion)

5. TYPES
• Adenocarcinoma
• Squamous cell carcinoma

6. REFLUX ESOPHAGITIS
• Esophageal irritation and inflammation
• Stratified squamous epithelium in esophagus lack special
mechanisms to resist the insult from gastric acid unlike
mucosa of stomach wall
• Decreased tonicity of lower esophageal sphincter or
increased abdominal pressure

8. BARRETT ESOPHAGUS
• Complication of chronic Gastroesophageal
reflux disease (GERD)
• Intestinal metaplasia within squamous
mucosa
• Increased risk for adenocarcinoma
• Squamous epithelial cells transformed to
non ciliated columnar epithelium with goblet
cells
• Progression in metaplasia to dysplasia
sequence

9. ADENOCARCINOMA
• Most commonly arise from Barrett esophagus
• Extended period through stepwise acquired genetic changes
• Mostly in lower third of esophagus

10. ADENOCARCINOMA
• Chromosomal abnormalities including
mutation in TP53, downregulation of
CDKI and amplification of cyclins
• Tumors produce mucin and form
glands
• Similar to gastric carcinomas tumor
can be intestinal or less commonly
diffuse type(signet-ring cells)

11. SQUAMOUS CELL
CARCINOMA
• Nutritional deficiencies as well as polycyclic
hydrocarbons and nitrosamines along with HPV can be
a risk factor
• Amplification of transcription factor gene SOX2,
overexpression of cyclin D1 and loss of function
mutations of TP53,E-cadherins and NOTCH1

12. SQUAMOUS CELL
CARCINOMA
• Most common site is middle third of esophagus
• Tumor masses over time protrude and obstruct the lumen
• Diffuse infiltrative lesions spread in the esophagus causing
thickening, rigidity and luminal narrowing
• Metastasis by lymphatic pathway due to rich lymphatic
network