Eosophageal Neoplasms

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The most common malignant tumours of the oesophagus are squamous carcinomas and adenocarcinomas
Squamous carcinomas are most common in the middle and lower oesophagus. The disease usually
presents late, when the tumour has become large enough to compromise the oesophageal lumen and cause dysphagia.
Adenocarcinomas mostly affect the lower oesophagus, arising in areas of epithelial
metaplasia (Barrett's oesophagus).
The prognosis for both types of carcinoma is poor,that for squamous carcinoma being slightly better
than adenocarcinoma because it is more responsive to radiotherapy. Fewer than 10% of patients
survive for five years.
Benign tumours of the oesophagus are uncommon
Most of the rare benign oesophageal tumours are leiomyomas.

There is great geographical variation in the incidence of oesophageal carcinoma, and it is
particularly common in the Far East, especially in China and Japan. Tumours are most common
in males after the fifth decade, and can be divided into two main histological types:
Squamous carcinomas are most common in the middle and lower oesophagus. They mostly
develop in men who are heavy alcohol drinkers or heavy smokers, and may be preceded by epithelial
dysplastic change. The disease usually presents late, when the tumour has become large enough to compromise the oesophageal lumen and cause dysphagia.

Regional lymph node spread is early and common.
Adenocarcinomas mostly affect the lower oesophagus, arising in areas of epithelial metaplasia
(Barrett's oesophagus). Some adenocarcinomas may represent a primary carcinoma of the stomach that
has infiltrated into the lower oesophagus.
These tumours tend to metastasize via lymphatics at an earlier stage than squamous carcinomas.
The prognosis for both types of carcinoma is poor, that for squamous carcinoma being slightly better
than adenocarcinoma because it is more responsive to radiotherapy. Fewer than 10% of patients
survive for five years.

Squamous carcinomas of the upper oesophagus, located in the post-cricoid region, are very rare
and are usually linked to the Plummer-Vinson syndrome, most common in middle-aged and elderly women.
Rare malignant primary tumours of the oesophagus include malignant melanomas, small cell
neuroendocrine carcinomas, and sarcomas.
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