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Echo Cardiography (2D, M Mode) |
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The esophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue. Esophageal cancer starts at the inside lining of the esophagus and spreads outward through the other layers as it grows.
Esophageal cancer is malignancy of the esophagus. There are various subtypes. Esophageal tumors commonly lead to dysphagia (difficulty swallowing), pain and other symptoms, and is diagnosed with biopsy. Small and localized tumors are treated with surgery, and advanced tumors are treated with chemotherapy, radiotherapy or combinations. Prognosis depends on the extent of the disease and other medical problems, but is fairly poor. |
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COLOR DOPPLER |
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Signs and symptoms
Dysphagia (difficulty swallowing) is the first symptom in most patients. Odynophagia (painful swallowing) may be present. Fluids and soft foods are commonly tolerated, while hard or bulky substances (such as bread or meat) cause much more difficulty. Substantial weight loss is characteristic as a result of poor nutrition and the active cancer. Pain, often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character.
The presence of the tumor may disrupt normal peristalsis (the organised swallowing reflex), leading to nausea and vomiting, regurgitation of food, coughing and an increased risk of aspiration pneumonia. The tumor surface may be fragile and bleed, causing hematemesis (vomiting up blood). Compression of local structures occurs in advanced disease, leading to such problems as superior vena caval obstruction (SVCO).
If the disease has spread to elsewhere, this may lead to symptoms related to this: liver metastasis could cause jaundice and ascites, lung metastasis could cause shortness of breath, pleural effusions, etc. |
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Ultrasound |
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Cause and risk factors
There are many risk factors for esophageal cancer. Some subtypes of cancer are linked to particular risk factors:
Age and sex. Most patients are over 60, and it is more common in men.
Tobacco smoking and heavy alcohol use increase the risk, and together appear to increase the risk more than these two individually.
Swallowing lye or other caustic substances
Particular dietary substances, such as nitrosamine
A medical history of other head and neck cancers increases the chance of developing a second cancer in the head and neck area, including esophageal cancer.
Plummer-Vinson syndrome (anemia and esophageal webbing)
Tylosis and Howel-Evans syndrome (hereditary thickening of the skin of the palms and soles)
Gastroesophageal reflux disease (GERD) and its resultant Barrett's esophagus increase oesophageal cancer risk due to the chronic irritation of the mucosal lining (adenocarcinoma is more common in this condition), while all other risk factors predispose more for squamous cell carcinoma.
Risk appears to be less in patients using aspirin or related drugs (NSAIDs). Statistically, it appears that Helicobacter pylori, known for increasing risk for gastric cancer, actually decreases the risk of esophageal cancer (O'Connor 1999); the exact mechanism for this phenomenon is unclear. |
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