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CANCERUL DE ESOFAG

CANCERUL DE ESOFAG. CONSIDERATII GENERALE. ETIOLOGIE. alcool si tutun prezenta de nitrosamine in mancare si apa contaminarea mancarii cu fungi malnutritia deficienta cronica de fier deficienta cronica de vitamine. Stari precanceroase. acalasia- incidenta de 7 ori mai mare

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CANCERUL DE ESOFAG

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  1. CANCERUL DEESOFAG

  2. CONSIDERATII GENERALE

  3. ETIOLOGIE • alcool si tutun • prezenta de nitrosamine in mancare si apa • contaminarea mancarii cu fungi • malnutritia • deficienta cronica de fier • deficienta cronica de vitamine

  4. Stari precanceroase • acalasia- incidenta de 7 ori mai mare • esofagita coroziva • esofagul Barrett • reflux esofagian • sindromul Plummer Winson • factori virali • malformatii congenitale

  5. INCIDENCE

  6. Anatomopatologie • Carcinom scuamos • Adenocarcinom Forme rare • Chistadenocarcinom • Carcinom cu celule mici • Sarcom • Melanom malign

  7. Forme anatomo-patologice • Ulcerativ • Infiltrativ • Superficial

  8. Piesa de exereza tumora cardia

  9. Aspect microscopic

  10. Cai de diseminare 1.Invazie directa, de vecinatate: -extramural -intramural: proximal si distal 2.Invazie pe cale limfatica: -ggl. cervicali -ggl. mediastinali -ggl. trunchi celiac 3.Invazie hematogena: -plamani, oase, ficat, suprarenale

  11. Semne clinice A.Simptome si semne - sindrom esofagian: • Disfagie progresiva: alimente solide, lichide • Regurgitatii • Sialoree • Pierdere in greutate • Astenie • Dureri retrosternale la deglutitie • Tuse la deglutitie = fistula esotraheala, bronsica • Disfonia = invazia n. recurenti

  12. Explorari imagistice • Radiologia: tranzit baritat, Rx toracic • Esofagoscopie si bronhoscopie • Ex. Bioptic si citologic • ECO:ficat, rinichi, suprarenale, adenopatie • ECO transluminal • Tomografie computerizata • Rezonanta magnetica

  13. Examen baritat Extensia tumorii in ax

  14. Carcinom scuamos Imagine endoscopica

  15. Adenocarcinom Imagine endoscopica

  16. Imagine endoscopica Carcinom infiltrativ

  17. Imagine endoscopica Carcinom vegetant, obstructiv cu retentie de corpi straini (medicamente)

  18. Ecografie transluminala

  19. Tomografie computerizata

  20. Semne principale de diagnostic: • Disfagie progresiva initiala pentru solide • Pierdere progresiva in greutate • Examene radiologice • Endoscopie cu biopsie si citologie

  21. T (tumora) T0 = nu se evidentiaza tumora (in situ) T1 = tumora invadeaza mucoasa, posibil submucoasa, fara musculara T2 = tumora invadeaza musculara T3 = tumora depasesta musculara N (adenopatia) N0 = fara metastaze ggl. N1 = metastaza ggl. regionala N2 = metastaza ggl. regionala multipla N3 = metastaza ggl. la distanta (trunchi celiac, laterocervical) M (metastaza) M0 = fara metastaza la distanta M1 = cu metastaza la distanta (cale hematogena) Stadializare TNM

  22. Stadializare postoperatorie Stadiu I T0-1 N0 M0 Stadiul II T2 N0 M0 Stadiul III T3 N0 M0 orice T, orice N, M0 Stadiul IV orice T, orice N, M1

  23. Diagnostic diferential • Tumori benigne • Alte afectiuni ale esofagului: - acalazia - reflux gastroesofagian - diverticuli esofagieni - hernia hiatala -stenoze esofagiene benigne • Compresiuni extrinseci (tumori mediastinale, etc.)

  24. Evolutie, complicatii • Sangerare (HDS) • Invazia structurilor mediastinale • Fistule: esotraheala, esobronsica, vasculara • Pneumonie de aspiratie - abces pulmonar

  25. Complicatii - fistula esobronsica

  26. Tratament • Chirurgical: • - curativ • - paleativ • Radioterapie • Chimioterapie

  27. Criterii de nerezecabilitate • Invazie traheobronsica, aortica (bronhoscopie, tomografie) • Criterii radiologice (lungimea tumorii in ax peste 5 cm) • Fistula esobronsica, invazia nervilor recurenti (raguseala) • Metastaze la distanta

  28. Radioterapie • Carcinomul scuamos este radiosensibil • Radioterapie + chirurgie (stadiul III) • Chimioterapie (stadiul IV)

  29. Operatii curative (radicale) Esogastrectomie polara superioara cu anastomoza esogastrica termino-terminala intratoracica

  30. Operatii curative Esogastrectomie totala cu splenectomie

  31. Operatii paleative Esogastroanastomoza

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