An Analytical study of Carcinoma Esophagus and Its Surgical Management

INTRODUCTION : Carcinoma esophagus is the 6th most common cancer in the world. Worldwide incidence is 160/100000. Incidence is more in kazakhastan. Squamous cell carcinoma accounts for most of the esophageal cancers. In USA adenocarcinoma is prevalent. Male to female ratio is 3:1 in squamous cell carcinoma. In adenocarcinoma it is 15:1. Mostly seen in fifth decade of life. Rare before the age of 30 years. squamous cell cancers arise from the squamous epithelium of the esophagus. Smoking and alcohol increases the risk for foregut cancers. Nitrosamines, longterm ingestion of hot liquids, vitamin A deficiency, zinc deficiency, achalasia, bulimia,Plummer Winson syndrome also accounts for causative factors. Adenocarcinomas are due to increasing incidence of GERD, western diet, increased use of acid suppression drugs. In recent years the improved standard of investigations and surgical technique and perioperative and post operative care substantial reduction in morbidity and mortality has been achieved. But still most of the patients could not be diagnosed earlier because of the late Presention. Study of the carcinoma esophagus is interesting because of its biological behavior. It infilterates locally, involves adjacent lymphnodes, and metastasizes widely by hematogenous spread. The prognosis and survival rate is poor in esophageal carcinoma. Overall 5 year survival rate is with treated tumour is only 5-12% AIM OF THE STUDY : The objectives of this prospective clinical study are 1) To know the incidence of carcinoma with regards to age, sex in our region 2) To study the common histological types of carcinoma esophagus 3) To know the clinical features & possible investigations to aid the diagnosis 4) To know the common site of carcinoma in esophagus 5) To know the operability of the carcinoma esophagus MATERIALS AND METHODS This is a prospective study of 88 patients of carcinoma esophagus who were admitted in thanjavur medical college hospital from September 2013-june 2015. Total number of 52 carcinoma esophagus admitted in our hospital during this study period were 112. Out of which 24 patients in whom the carcinoma arising from cervical esophagus were excluded from the study. METHODS : The methods include, obtaining the important information from the patients through history thorough clinical examination and doing the investigations, what ever is necessary to aid the diagnosis and respectability. All the informations were entered in a proforma, specially designed for this study. METHODOLOGY : The following factors were taken into consideration while evaluating the patients. Age and sex incidence, Geographical factors, Socio economic status, Personal habits, Symptoms and duration, Predisposing factors. In all these patients, nourishment was noted. RESULTS : The incidence of carcinoma esophagus, by this study in our institution is 5.2% (112/2120). Total number of cancer patients in our hospital during this study period were 2120. CONCLUSION : Carcinoma esophagus is one among the cancers that have increased male: female ratio. More commonly occuring in a low socioeconomic groups. • The predominant histology is squamous cell variety. • There is significant rise of adenocarcinoma. • A strong association coexists between carcinoma esophagus with smoking and Alcoholism. • Transhiatal esophagectomy and thoracoscopic esophagectomy scores significant role in surgical management of lower 1/3 and middle 1/3 carcinomas. • Around 50% of the patients when diagnosed is in inoperable stage. • Inoperability is due to biological nature of the disease, in which feeding jejunostomy and followup RT is the treatment option. • Significant 1 year survival rate can be achieved by with transhiatal as well as thoracoscopic esophagectomy