161. Precancer and cancer of the esophagus: pathological anatomy. Forms of growth, features of esophageal cancer metastasis, complications, outcomes, clinical significance.

Among precancerous changes, dysplasia of the epithelium of the mucous membrane is of the greatest importance. The condition associated with it is called Barrett's esophagus.

Barrett's esophagus is an acquired condition, which is defined as an epithelial metaplasia zone circularly located above the lower border of the esophageal-gastric junction (Z-line), extending proximally by 3 cm or more and histologically represented by villous connective tissue structures covered with intestinal epithelium with the obligatory presence of goblet cells.

Macroscopically, foci of metaplastic epithelium have the appearance of flaming tongues spreading in the proximal direction from the Z-line.

Esophageal cancer often occurs at the border of the middle and lower third of it, which corresponds to the level of tracheal bifurcation.

Chronic irritation of the mucous membrane of the esophagus (hot coarse food, alcohol, smoking), scarring after a burn, chronic gastrointestinal infections, structural disorders (diverticula), ectopia of the cylindrical epithelium and gastric glands predispose to the development of esophageal cancer.

The following macroscopic forms of esophageal cancer are distinguished:

-Ring-shaped dense cancer is a tumor formation that circularly covers the wall of the esophagus in a certain area. The lumen of the esophagus is narrowed. With the decay and ulceration of the tumor, the patency of the esophagus is restored.

-Papillary cancer of the esophagus is similar to fungal cancer of the stomach. It easily disintegrates, resulting in ulcers that penetrate into neighboring organs and tissues.

-Ulcerated cancer is a cancerous ulcer that has an oval shape and is elongated along the esophagus.

Among the microscopic forms of esophageal cancer, carcinoma in situ, squamous cell carcinoma, adenocarcinoma, glandular squamous cell, glandular cystic, mucoepidermal and undifferentiated cancers are distinguished.

Metastasis: Lymphogenic, hematogenic, can also grow into neighboring organs (mediastinum, pleura, pericardium, trachea)

Complications: Germination into neighboring organs with the formation of fistulas, bleeding, esophageal gangrene, sepsis, aspiration pneumonia, mediastinitis, pericarditis, pleurisy.

Outcomes: surgical treatment in combination with chemotherapy, death (cachexia, pneumonia, asphyxia, anemia).

Clinic: Early symptoms.

A small tumor of the esophageal mucosa develops asymptomatically for 1-2 years.

Dysphagia is a feeling of difficulty passing food through the esophagus (behind the sternum).

Hypersalivation.

Pain when swallowing.

The feeling of "scratching" behind the sternum.

Symptoms of a common tumor process.

Bad breath.

Unpleasant taste in the mouth.

Belching, nausea, regurgitation.

Pain behind the sternum, in the interscapular area, in the heart area.

Loss of appetite, weight loss, choking on food, coughing during meals.