ESOPHAGEAL TUMORS – CLASSIFY , MORPHOLOGY AND ETIOLOGY
ESOPHAGEAL TUMORS The vast majority of esophageal cancers fall into one of two types Adenocarcinoma Squamous cell carcinoma
Other malignancies of the esophagus are far less common and include Undifferentiated carcinoma Carcinoid tumor Melanoma Lymphoma Sarcoma.

Squamous cell carcinoma is more common worldwide but adenocarcinoma is on the rise in the United States and other Western countries.
ADENOCARCINOMA
Adenocarcinoma of the esophagus typically arises in a background of Barrett esophagus and long-standing GERD.
Risk of adenocarcinoma - if documented dysplasia and is further increased by tobacco use, obesity, and prior radiation therapy.
Risk of adenocarcinoma is reduced by diets rich in fresh fruits and vegetables.
PATHOGENESIS.
Esophageal adenocarcinoma usually occurs in the distal third of the esophagus and may invade the adjacent gastric cardia.
Gross –
Initially appearing as flat or raised patches
Large masses of 5 cm or more in diameter may develop.
Tumors may infiltrate diffusely or ulcerate and invade deeply.
MICROSCOPICALLY
Barrett esophagus is frequently present adjacent to the tumor.
Tumors most commonly produce mucin and form glands often with intestinal-type morphology.
Less frequently tumors are composed of diffusely infiltrative signet-ring cells.
SQUAMOUS CELL CARCINOMA ï‚¢
Esophageal squamous cell carcinoma occurs in adults over age 45 and affects males four times more frequently than females.
Pathogenesis. Risk factors include alcohol and tobacco use, poverty, caustic esophageal injury, achalasia,Plummer-Vinson syndrome, and frequent consumption of very hot beverages
Nutritional deficiencies, Polycyclic hydrocarbons, nitrosamines, and other mutagenic compounds, such as those found in fungus contaminated foods.
Human papillomavirus (HPV) infection has also been implicated in esophageal squamous cell carcinoma in high-risk areas
MORPHOLOGY Half of squamous cell carcinomas occur in the middle third of the esophagus . Squamous cell carcinoma begins as an in situ lesion termed squamous dysplasia
Gross – Early lesions appear as small, gray-white, plaquelike thickenings.

The sites of lymph node metastases vary with tumor location cancers in the upper third of the esophagus favor cervical lymph nodes.

Those in the middle third favor mediastinal, paratracheal and tracheobronchial nodes and those in the lower third spread to gastric and celiac nodes.