esophageal ca
TRANSCRIPT
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ESOPHAGEAL CANCER
Esophageal cancer is a cancerous(malignant) tumor of the esophagus, the
muscular tube that moves food from the
mouth to the stomach.
Esophageal cancer can be of two cell type:
adenocarcinoma and squamous cell
carcinoma.
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PATHOPHYSIOLOGYRisk factor:
Chronic ingestion of hot liquids or food , GERD, Nutritional deficiency,
Barretts esophagus, Poor oral hygiene, Cigarette smoking
Adenocarcinoma squamous cellcarcinoma
Cancer cell arise from the surface area of esophagus
Chronic esophageal irritation/ tumor
Dysphagia
Sensation mass in throat
Painful swallowingSubsternal pain or fullness
Regurgitation of undigestive food
Obstruction of esophagus
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STAGING/GRADING
Staging of squamous cell carcinoma of theesophagus
Stage 0: This is the same as Tis cancer, in
which cancer is found in only the top lining ofthe esophagus (Tis, N0, M0, G1)
Stage IA: This is the same as T1 cancer, in
which the cancer is located in only the twoinside layers of the esophagus. (T1, N0, M0,
G1)
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Stage IB: Either of these two conditions:
The cancer is located in only the two inside
layers of the esophagus, but the tumor cells
are less differentiated (T1, N0, M0, G2 or G3)
The tumor is located in the lower part of the
esophagus, and the cancer has spread to
either of the two outer layers of the
esophagus, but not to the lymph nodes orother parts of the body. (T2 or T3, N0, M0,
G1)
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Stage IIA: Either of these two conditions:
The tumor is located in the upper or middle
part of the esophagus, and the cancer is ineither of the two outer layers of theesophagus. (T2 or T3, N0, M0, G1),
The tumor is located in the lower part of theesophagus, and the cancer is in either of thetwo outer layers of the esophagus. The tumorcells are less differentiated. (T2 or T3, N0,
M0, G2 or G3)
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Stage IIB: Either of these two conditions:
The tumor is located in the upper or middlepart of the esophagus, and cancer is in either
of the two outer layers of the esophagus. The
tumor cells are less differentiated. (T2 or T3,N0, M0, G2 or G3),
Cancer is in the inner layers of the
esophagus and has spread to one or twolymph nodes near the tumor. (T1 or T2, N1,
M0, any G)
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Stage IIIA: Any of these three conditions:
Cancer is in the inner layers of the
esophagus and has spread to three to six
lymph nodes near the tumor. (T1 or T2, N2,
M0, any G)
Cancer is in the outside layer of the
esophagus, with involvement of one or two
lymph nodes. (T3, N1, M0, any G)
Cancer has spread beyond the esophagus to
nearby tissue, but no spread to lymph nodes
or other areas of the body (T4a, N0, M0, any
G)
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Stage IIIB: Cancer is in the outside layer of theesophagus and in three to six lymph nodes. (T3,N2, M0, any G)
Stage IIIC:Any of these three conditions: Cancer has spread beyond the esophagus into
nearby tissue. Cancer is also in six or lesslymph nodes. (T4a, N1 or N2, M0, any G)
Cancer has spread beyond the esophagus intonearby tissue, but cannot be removed bysurgery. (T4b, any N, M0, any G)
Cancer involves seven or more lymph nodes,but has not spread to distant parts of the body.(any T, N3, M0, any G)
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Stage IV: Cancer has spread to another partof the body (any T, any N, M1, any G)
Staging of adenocarcinoma of theesophagus
Stage 0: This is the same as Tis cancer, in
which cancer is found in only the top lining ofthe esophagus (Tis, N0, M0, G1)
Stage IA: This is the same as T1 cancer, in
which the cancer is located in either of thetwo inside layers of the esophagus only. (T1,
N0, M0, G1 or G2)
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Stage IB: Either of these two conditions:
The cancer is located in either of the two
inside layers of the esophagus only, and the
tumor cells are poorly differentiated (T1, N0,
M0, G3),
The cancer has spread to an outer layer of
the esophagus, but not to the lymph nodes or
other parts of the body. (T2, N0, M0, G1 or
G2)
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Stage IIA: Cancer is in an outer layer of theesophagus, and the cells are poorly
differentiated. (T2, N0, M0, G3)
Stage IIB: Either of these two conditions:
Cancer is in the outside layer of theesophagus, but not beyond. (T3, N0, M0, any
G)
Cancer is in an inner layer or the muscularis
propria of the esophagus, and involves one
or two lymph nodes. (T1 or T2, N1, M0, any
G).
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Stage IIIA: Any of these three conditions:
Cancer is in the inner layers of the
esophagus and has spread to three to sixlymph nodes near the tumor. (T1 or T2, N2,M0, any G), or
Cancer is in the outside layer of theesophagus, with involvement of one or twolymph nodes. (T3, N1, M0, any G), or
Cancer has spread beyond the esophagus tonearby tissue, but there is no spread tolymph nodes or other areas of the body (T4a,N0, M0, any G)
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Stage IIIB: Cancer is in the outside layer of theesophagus and in three to six lymph nodes. (T3,N2, M0, any G)
Stage IIIC:Any of these three conditions: Cancer has spread beyond the esophagus into
nearby tissue. Cancer is also in six or lesslymph nodes. (T4a, N1 or N2, M0, any G)
Cancer has spread beyond the esophagus intonearby tissue, but cannot be removed bysurgery. (T4b, any N, M0, any G)
Cancer involves seven or more lymph nodes,but has not spread to distant parts of the body.(any T, N3, M0, any G)
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Stage IV: Cancer has spread to another partof the body (any T, any N, M1, any G)
Recurrent: Recurrent cancer is cancer thatcomes back after treatment. It may come
back in the esophagus or in another part of
the body.
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CLINICAL MANIFESTATION
Many of patients have an advanced ulceration
lesion of the esophagus before symptoms is
manifested.
Symptoms include dysphagia, initially solidfoods and eventually with liquids, a sensation of
a mass in the throat, painful swallowing,
substernal pain of fullness, and, later,regurgitation of undigested food with foul breath
with hiccups.
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The patient first becomes aware of
intermittent and increasing difficulty in
swallowing.As the tumor grows and the obstruction is
nearly complete, even liquids cannot pass
into the stomach.Regurgitation of food and saliva occurs,
hemorrhage may take place, and the
progresses loss weight and strengthoccurs from inadequate nutrition.
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Later symptoms include substernal pain,
persistent hiccup, respiratory difficulty, and
foul breath.
The delay between the onset of early
symptoms and the patient seeking medical
advice is often 12 to 18 months.
Any person having difficulty swallowing
difficulties should be encouraged toconsult physician immediately.
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MEDICAL MANAGEMENT
Treatment may include surgery, radiation,chemotherapy, or combination of thesemodalities depending on the type ofcancer cell, the extent of the disease, and
the patient cancer includes the following:
preoperative combination chemotherapyand radiation therapy for 4 to 6 weeks;
followed by no medical intervention for 4weeks;
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lastly surgeon resections of the
esophagus.Standard surgical management includes
the total resection of the esophagus
(esophagectomy) with removal of tumorplus a wide tumor margin of the
esophagus and the lympnodes in the area.
The surgical approach maybe through the
thorax or the abdomen, depending on the
location of the tumor.
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When the tumor occur in the cervical or
upper thoracic area, esophageal
continuity maybe maintained by a free
jejuna graft transfer, in which the tumor
removed and the area is replaced with a
portion of jujenum.A segment of a colon maybe used, or the
stomach can be elevated into the chest
and the proximal section of the esophagusanastomosed to the stomach.
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NURSING MANAGEMENT
Assessment
Asses the patient for backwards movement
of food through the esophagus and possibly
mouth (regurgitation), chest pain unrelated toeating difficulty swallowing solids or liquids,
heartburn, vomiting blood, weight loss
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Diagnosis
Imbalanced nutrition, less than bodyrequirements, related to difficulty swallowing
Risk for aspiration related to difficultyswallowing or to tube feeding
Acute pain related to difficulty swallowing,ingestion of an abrasive agent, tumor, orfrequent episodes of gastric reflux
Deficient knowledge about the esophageal
disorder, diagnostic studies, medicalmanagement, surgical intervention, andrehabilitation
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Planning
The major goals for the patient mayinclude attainment of adequate nutritional
intake, avoidance of respiratory
compromise from aspiration, relief of pain,and increased knowledge level
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Nursing Interventions
Encouraging adequate nutritional intake
Decreasing risk of infection
Relieving pain Providing patient Education
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ESOPHAGEAL
CANCER
PREPARED BY:
CHARLES JO FRITZ MACALDEDOMINIC ROY PANES
LONA GRACE TRIBUNSAY
CHRISTY PADERNILLA
SUBMITTED TO:
MRS. FAITH FRANCES L. LIBARIOS, R.N.