INSTITUTO POLITECNICO NACIONAL. ESCUELA SUPERIOR DE MEDICINA. HOSPITAL JUAREZ CENTRO. DR. ALAN ROBERTO GARCIA MARIN. ALUMNAS: GIL FREGOSO LAURA. MARTINEZ SANTIAGO JOCABET
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1. TNM.
2. EPIDEMIOLOGA Incidencia Occidente Poco frecuente China,
Rusia, Irn y Sudfrica comn En Mxico Relacin 2:1
3. Endoscopy of Peptic Stenosis due to a Reflux Esophagitis
This 57 year-old man with long-standing reflux disease. Peptic
strictures are sequelae of gastroesophageal refluxinduced
esophagitis, and they usually originate from the squamocolumnar
junction and average 1-4 cm in length
4. DIVERTCULOS ESOFGICOS Se relacionan con 0.4% de los px con
Ca esofgico. MEMBRANAS ESOFGICAS Se relacionan con el Sindrome de
Plummer Vinson. Ms frecuente en mujeres. 10% de las afectadas sufre
ste cncer.
5. TILOSIS Hiperqueratosis palmar, plantar ms papilomatosis
esofgica. Sx autosmico dominante. Tiene ms de 50% de posibilidades
de generar cncer.
6. Metaplasia del epitelio esofgico por islotes de epitelio
cilndrico en el segmento inferior del esfago. Hay un riesgo mayor
de 15% de padecer adenocarcinoma. ESFAGO DE BARRETT Staining of the
mucosa with Lugol's solution during endoscopy has been suggested to
identify early cancer and dysplasia that may improve prognosis. It
has been shown that 40-60% of patients with typical reflux symptoms
have no esophageal mucosal injury. Lugol chromoendoscopy may be
useful for the diagnosis of so-called endoscopy-negative GERD.
7. Antecedente de ingestin de custicos leja. Exposicin a
radiacin. Ocupaciones como: cantineros, camareros y obreros de la
construccin.
8. TUMOR SEGUNDO PRIMARIO VIRUS ENFERMEDAD CELIACA DE LARGA
EVOLUCIN Px con antecedente de Ca de vas respiratorias y digestivas
altas 4% sufrir segundos tumores primarios. Px con Ca de cabeza y
cuello 35% VPH Riesgo mayor de Ca. causas: toxicidad del gluten
sobre el epitelio y alteraciones nutricionales.
9. PATOLOGA CARCINOMA EPIDERMOIDE O DE CELS ESCAMOSAS Y EL
ADENOCARCINOMA Tumores epiteliales ms frecuentes
10. CARCINOMA EPIDERMOIDE 90% de los casos Localiza esfago
torcico medio 50-65% y en el tercio inferior en 25-35%. Se
relaciona con Acalasia, Snd de Plummer Vinson y divertculos
esofgicos.
11. CA CELULAS ESCAMOSAS. El esfago est normalmente cubierto
con clulas escamosas. Al cncer que se origina en estas clulas se le
llama carcinoma de clulas escamosas, el cual puede ocurrir en
cualquier lugar a lo largo del esfago.
12. Adenocarcinoma. Se originan de clulas glandulares se llaman
adenocarcinomas. Este tipo de clula no es normalmente parte del
revestimiento interno del esfago. Antes de que se pueda desarrollar
un adenocarcinoma, las clulas glandulares tienen que reemplazar un
rea de las clulas escamosas, como en el caso del esfago de
Barrett.
13. CARCINOMA EPIDERMOIDE Macroscpicamente 3 variantes:
fungosos, ulcerados y con infiltracin difusa. Tumor constituido por
nidos de cels cohesivas, poligonales, ovales o fusiformes que
presentan perlas de queratina en su citoplasma y frecuentes
fenmenos de disqueratosis. Variedades histolgicas ms frecuentes:
carcinoma in situ, carcinoma escamoso con patrn sarcomatoide y
carcinoma verrugoso.
14. ADENOCARCINOMA DE ESFAGO Representa de 2-5% de la totalidad
de los casos. Ms frecuente en el tercio inferior 60% 60-80% de los
px se origina a partir del esfago de Barrett. Otros tipos
histolgicos raros: Ca adenoescamoso, leiomiosarcoma, Ca de cels
pequeas y Sarcoma de Kaposi.
15. Endoscopy of Esophageal Squamous Cell Carcinoma. Ulcerating
Squamous cell carcinoma of the lower end of the esophagus. This 72
year-old female, presented with progressive dysphagia. In order to
determinate the etiology an upper endoscopy was carried out.
16. Endoscopic appearance of Esophageal Squamous Cell
Carcinoma. Squamous cell carcinoma of the esophagus is largely
associated with a poor prognosis, and the development and
metastasis of this tumour are complicated. Direct invasion of
adjacent organs such as the aorta, respiratory tract and lungs, and
distant metastasis to other organs such as the liver, lungs and
bone are commonly found in advanced esophageal cancer cases.
Intramural metastasis (IMM) in the esophagus has been found in
about 10% of esophageal cancer cases. However, IMM to the stomach
(IMMS), excluding direct invasion and spread to the stomach, is
relatively rare.
17. Endoscopic Picture of Esophageal Carcinoma. The gastric
fundus shows a large fungating and ulcerating lesion, retroflexed
image. A history of smoking and/or alcoholism is often present in
patients with esophageal squamous carcinoma, while a history of
Barrett's esophagus precedes development of esophageal
adenocarcinoma in many cases. Pathophysiology Esophageal carcinoma
arises in the mucosa. Subsequently, it tends to invade the
submucosa and the muscular layer and, eventually, contiguous
structures such as the tracheobronchial tree, the aorta, or the
recurrent laryngeal nerve. The tumor also tends to metastasize to
the periesophageal lymph nodes and, eventually, to the liver,
lungs, or both.
18. Epidemiology At least 5X more common is men with the
male/female ratio varying markedly worldwide, probably representin
the variable exposure to environmental factors At least 4X more
common in blacks in the U.S., with the incidence in blacks rising
while the incidence in whites is stable or declining A disease of
older people with a mean age of onset of 60 yrs. which probably
reflects the slow evolution of the dysplasia carcinoma
sequence.
19. } Etiology. Examination of geographic areas of high
incidence have identified a number of environmental factors
strongly linked to the development ofesophageal dysplasia and
squamous carcinoma. In the United States and Europe alcohol and
smoking In China nitrosamine containing foods, fungal contamination
of foods and vitamin and essential metal deficiency. The only known
genetic predisposition occurs in hereditary tylosis, an autosomal
dominant symmetrical keratosis of the palms and soles.
20. BIBLIOGRAFIA. http://www.gastrointestinalatlas.com/english/
esophageal_dilatation.html Esophagus The Japan Esophageal Society
and Springer Japan 2014 10.1007/s10388-014-0459-z
