Special Case of Adenocarcinoma

Special case of adenocarcinoma Its only recognized risk factor is Barrett's ulcer following chronic gastroesophageal reflux, a risk which is also increased when taking diphosphonates. In the United States, esophageal cancer is most commonly (about 70% of cases) an adenocarcinoma, but globally it is still most commonly a squamous cell carcinoma. Very lymphophilic (adjacent and supraclavicular lymph nodes), it metastasizes to the liver, lungs and skeleton. It is located in 10% of cases in the upper third of the esophagus, 35% in its middle third and 55% in its lower third (but these statistics vary a little depending on the studies). Adenocarcinoma follows chronic gastroesophageal reflux, Barrett's ulcer being in fact the only known risk factor for esophageal adenocarcinoma. Currently, the incidence of squamous cell carcinoma is decreasing among whites and blacks, while that of adenocarcinoma is increasing, primarily in whites. Clinical signs only appear late in the progression of the disease, thus explaining the high rate of patients who are already inoperable at diagnosis. The two main manifestations of esophageal cancer are weight loss (60% of cases) and dysphagia (74% of cases). Dysphagia initially concerns solids, then becomes general (even saliva can no longer be swallowed, giving the false

impression of hypersialorrhea). Existence Dysphagia means that at least 60% of the circumference of the esophagus is infiltrated by cancer. Pain (retrosternal, epigastric or posterior), regurgitation, odynophagia (17%) or dyspnea (12%) are also reported. The clinical examination therefore provides almost nothing for the positive diagnosis of the disease, at most it can assess its impact. The assessment of a malignant tumor of the esophagus must firstly characterize the tumor (type, exact location, metastases ) and on the other hand assess the general condition of the patient in order to choose a treatment that he can tolerate (respiratory function, hydroelectrolytic state, etc.). The balance sheet essentially includes: - an esogastroduodenal transit; - an endoscopy (esogastroduodenoscopy) with biopsy (remember to check the gastric fundus); - a scan (more efficient than magnetic resonance imaging to visualize THE lymphadenopathy mediastinal); - an otorhinolaryngological and pulmonary examination with endoscopy (because there is a 15 to 30% association with ENT or bronchial cancer); - an ultrasound ( metastases liver, lymphadenopathy cervical). The treatment of esophageal cancer is essentially based on surgery, alone or in combination with radiotherapy and/or chemotherapy. However, the results are still not very satisfactory: the overall 5-year survival rate is less than 5%.