Cancer of the esophagus is the least researched and most aggressive on the course and prognosis of malignant epithelial cells. An indirect indicator of the aggressiveness of malignant tumors is the ratio of the total number of deaths from cancer localization within 1 year to the number of newly diagnosed patients in this nosology during the same year. This ratio is called the index of aggressiveness. For cancer of the esophagus, this index was 0.95. For comparison, lung cancer, this figure is 0.93, and for nosology such as breast, prostate and colon, it ranges from 0,16 to 0,23.

ETIOLOGY

Smoking is a risk factor for cancer of the esophagus, as squamous and adenocarcinoma. Inhalation of combustion products of tobacco leads to contact between carcinogens, especially nitrozoaminami, with the mucous membrane wall of the esophagus. The risk of cancer of the esophagus is directly proportional to the number of cigarettes smoked per day, and duration of smoking. Smokers experienced the risk of developing squamous cell carcinoma of the esophagus in 10 times, and adenocarcinoma in 2 times higher than that of non-smokers. Smoking cessation in 10 years leads to a significant decrease in the risk of developing squamous cell carcinoma of the esophagus, but the risk of developing adenocarcinoma of the esophagus remains high 30 years after smoking cessation. A history of radiotherapy for mediastinal region (in the treatment, for example, breast cancer, lymphomas and other tumors) also increases the likelihood of disease. In these cases, cancer of the esophagus develops through more than 10 years after radiotherapy.

 

Endoscopic picture and endosonogramma squamous cell carcinoma of the esophagus

 

ETIOLOGY squamous cell carcinoma of esophagus

Any factor that leads to chronic irritation and inflammation of the mucous membrane of the wall of the esophagus increases the risk of developing squamous cell carcinoma of the esophagus. Prolonged use of alcohol, especially when combined with smoking significantly increases your chances of developing squamous cell carcinoma (and to a lesser extent, adenocarcinoma), esophageal and explains 90% of cases This histological forms of cancer in developed countries. The combination of alcohol with smoking also leads to an increase in the incidence of cancer of the head and neck. 1-2% of patients with cancer of these locations, on closer inspection reveal and cancer of the esophagus. Other causes of chronic irritation of the esophagus are achalasia and diverticulum of the esophagus, where food, decaying, leads to the release of chemical agents. In some countries, the frequent use of excessively hot drinks also lead to more frequent appearance of esophageal cancer. Accidental consumption of alkali is an indication for close monitoring of these patients for developing cancer of the esophagus.

While cases of a family of cancer of the esophagus are described in some countries, neepidermoliticheskaya palmar-plantar keratoderma (tiloz) - a rare autosomal dominant disorder caused by an abnormality of chromosome 17q25, is the only syndrome, the presence of which predisposes to cancer of the esophagus. The syndrome is characterized by hyperkeratosis of palms and soles, thickening of the oral mucosa. In the presence of this syndrome in 95% of patients for 70 years develops cancer of the esophagus.

The development of squamous cell carcinoma (but not adenocarcinoma) is associated with low socio-economic status. Deficit disorder, such as Plummer-Vinson syndrome, characterized by dysphagia, iron deficiency anemia esophageal films, becoming increasingly rare to improved feeding conditions in developing countries.

In the presence of gastro-esophageal reflux disease, the risk of developing adenocarcinoma of the esophagus is increased in 7,7 times. Other states, accompanied by reflux, such as diaphragmatic hernia, esophageal ulcer, frequent use of antacids and histamine blockers, also increases the risk of developing cancer of the esophagus, but are not independent prognostic factors. Preparations, relaxing esophageal-zhelu -
dochny sphincter and increase reflux manifestations (antiholinergicheskie drugs, aminophylline, beta-blockers), explain the development of 10% of cases of adenocarcinoma. It is assumed that Helicobacter pylori (especially CagA positive strains), helping to reduce gastro-esophageal reflux disease (N. pilori promote the development of achlorhydria) , reduce the risk of adenocarcinoma, but this hypothesis remains unproven. As soon as the frequency of infection with N. pilori declining in the U.S. and Europe, the incidence of gastroesophageal reflux and Barrett's esophagus is increasing.

Obesity - another risk factor for adenocarcinoma. Increased body mass index is accompanied by increased risk of adenocarcinoma of the esophagus, thus decreasing the risk of contracting squamous cell carcinoma of the esophagus. The increase in the number of obese people, especially in Western countries, contributing to the observed in recent decades, increasing frequency of adenocarcinoma of the esophagus. One hypothesis to explain the impact of obesity on the incidence of esophageal cancer, increased intraabdominal pressure and gastro-esophageal reflux.