(BQ) Part 2 book “Surgery at a glance” has contents: Thyroid malignancies, parathyroid disease, pituitary disorders, ischaemic heart disease, valvular heart disease, peripheral arterial disease, extracranial arterial disease, postoperative pulmonary complications, and other contents. | 44 Oesophageal carcinoma DISTRIBUTION TYPES Postcricoid (10%) • Iron deficiency • Smoking Malignant stricture Malignant ulcer Invasive mass EFFECTS/SPREAD Upper/middle 1/3 (40%) • Smoking • Diet • Achalasia Carcinoma arising in Barrett’s Lower 1/3 - junctional (50%) • Barrett's oesophagus Supraclavicular node (Virchow's) Dyspnoea Cough Haemoptysis Mediastinal nodes AF Pericardial effusion TNM STAGING Muscle Gastric nodes Pleural effusion Adventitia Submucosa Dysphagia Dyspepsia T3 N3 >–7 +ve N2 3–6 +ve T4a Bone Type I and II junctional Total gastrectomy + Roux-en-y loop NO No +ve NOC NI 1–2 +ve T4b SURGICAL OPTIONS Type III junctional (large stomach element) Lung Mucosa TIS T1a T1b T2 Postcricoid Upper 1/3 Oesophagogastrectomy Oesophagectomy + interposition graft interposition graft Pharyngo(laryngo) oesophagectomy + 108 Surgery at a Glance, Fifth Edition. Pierce A. Grace and Neil R. Borley. © 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd. Definition Malignant lesion of the epithelial lining of the oesophagus. Key points • All new symptoms of dysphagia should raise the possibility of oesophageal carcinoma. • Adenocarcinoma of the oesophagus is increasingly common. • Only a minority of tumours are successfully cured by surgery. Epidemiology • Male : female 3:1, peak incidence 50–70 years. High incidence in areas of China, Russia, Scandinavia, among the Bantu in South Africa and black males in the USA. • Adenocarcinoma has the fastest increasing incidence of any carcinoma in the UK. Aetiology Predisposing factors: • Alcohol consumption and cigarette smoking. • Chronic oesophagitis and Barrett’s oesophagus – possibly related to biliary reflux. • Stricture from corrosive (lye) oesophagitis. • Achalasia. • Plummer–Vinson syndrome (oesophageal web, mucosal lesions of mouth and pharynx, iron deficiency anaemia). • Nitrosamines. • Elevated BMI – increased risk for adenocarcinoma. Pathology • Histological