1. Cancer oesophagus

2. Incidence
More common in men than women
Usually in the fifth decade of life
Aetiology
Chronic irritation – chronic oesophagitis
Alcohol – smoking – (tobacco)
Opium pipes
Excessively hot beverages
Nutritional deficiencies especially lack of fruits and vegetables (fruits and vegetables promote repair of irritated tissue)

3. Smoking

4. Chronic oesophagitis may predispose to ca oesophagus

5. Usually squamous cell epidermoid type
Pathophysiology
Usually squamous cell epidermoid type
Tumour cells spread beneath the oesophageal mucosa or directly into, through, and beyond the muscle layers into the lymphatics
In late stages obstruction of the gut
Perforation may occur into the mediastinum and erosion into the great vessels

6. Clinical manifestations
Dysphagia
Initially to solid foods and eventually to liquid food.
A feeling of a mass in the throat
Painful swallowing
Substernal pain or fullness.
Regurgitation of undigested food with foul breath
Hiccups
Intermittent and increasing difficulty in swallowing
Obstruction of the oesophagus  regurgitation of food and saliva – haemorrhage may take place – respiratory difficulty

7. Investigations
Oesophagoduodenoscopy – gastroscopy
Biopsy and brushings
Bronchoscopy – esp. in tumours of middle and upper third
Mediastinoscopy – to determine operability
Other routine blood investigations
Ultrasound scan – to determine secondaries in liver

8. Normal Oesophagus

9. Cancer Oesophagus

10. Barium Swallow showing cancer oesophagus

11. Ca oesphagus before and after chemoradiotherapy
Rat tail appearance

12. Ca oesophagus lower end irregular and proximal dilatation

13. Management
Surgery – oesopahgectomy, free jejunal graft, colon or elevation of stomach – tumours of the lower thoracic oesophagus are more amenable to surgery than are tumours located higher in the oesophagus
Radiation
Chemotherapy
A combination of these modalities

14. Cat scan machine

15. Lipoma oesophagus

16. Other modalities of treatment
Preoperative radiation therapy and chemotherapy may be given
Palliative treatment
to keep oesophagus open
to assist with nutrition
to control saliva
Dilatation of the oesophagus
Laser therapy
Placement of an endoprosthesis (stent)
Radiation and chemotherapy

17. Self expanding metal stent

21. Prognosis
Surgical resection
– high mortality
– infection
– pulmonary complications
– leak – postoperatively a nasogastric tube will be in place which should not be manipulated
– NPO until X-ray studies confirm that the anastomosis is secure and not leaking

22. Nursing Management Improve patient’s nutritional status
Prepare for surgery or radiation therapy or chemotherapy
High calorie, high protein diet in liquid or soft form
Total parenteral nutrition
Explain the various procedures and equipments that are going to be used

23. Nursing in Fowler’s position to assist in preventing reflux of gastric secretions.
Observe for regurgitation and dyspnoea
For aspiration pneumonia
Monitor temperature and look for seepage of fluids into the mediastinum
If grafting has been done watch for viability
Doppler study to assess blood supply to the graft.
Nasogastric tube if displaced make no attempt to replace
Nasogastric tube is removed after 5-7 days
Ba swallow performed before feeding

25. Patient is encouraged to eat after removal of the nasogastric tube
Chewing – Important
Home cooked food – family involvement encouraged.
Deal with excessive saliva – to prevent aspiration pneumonia