Clinical manifestations of squamous cell carcinoma of the esophagus begin insidiously and include dysphagia, odynophagia (pain on swallowing), and obstruction. As with other forms of esophageal obstruction, patients may unwittingly adjust to the progressively increasing obstruction by altering their diet from solid to liquid foods. Extreme weight loss and debilitation may occur as consequences of both impaired nutrition and tumor-associated cachexia. As with adenocarcinoma, hemorrhage and sepsis may accompany tumor ulceration. Occasionally, squamous cell carcinomas of the upper and mid esophagus present with symptoms caused by aspiration of food via a tracheoesophageal fistula.
Increased use of endoscopic screening has led to earlier diagnosis of esophageal squamous cell carcinoma. Early detection is critical, because 5-year survival rates are 75% for patients with superficial esophageal carcinoma but much lower for patients with more advanced tumors. The overall 5-year survival rate remains a dismal 9%.
DISEASESOFTHEESOPHAGUSrelated to the use of alcohol and tobacco, the effects of which synergize to increase riskrelated to the use of alcohol and tobacco, the effects of which synergize to increase risk
Esophageal obstruction mayoccurasaresultofmechanicalorfunctionalanomalies.Mechanicalcausesincludedevelopmentaldefects,fibroticstrictures,andtumors.
Achalasia, characterizedbyincompleteLESrelaxation,increasedLEStone,andesophagealaperistalsis,isacommonformoffunctionalesophagealobstruction.
Esophagitis canresultfromchemicalorinfectiousmucosalinjury.Infectionsaremostfrequentinimmunocompromisedindividuals.
Themostcommoncauseofesophagitisisgastroesophageal reflux disease (GERD), whichmustbedifferentiatedfromeosinophilic esophagitis.
Barrett esophagus, whichmaydevelopinpatientswithchronicGERD,isassociatedwithincreasedriskfordevelopmentofesophagealadenocarcinoma.
Esophageal squamous cell carcinoma isassociatedwithalcoholandtobaccouse,poverty,causticesophagealinjury,achalasia,tylosis,andPlummer-Vinsonsyndrome.
http://ebooksmedicine.net
Disorders of the stomach are a frequent cause of clinical disease, with inflammatory and neoplastic lesions being particularly common. In the United States, symptoms related to gastric acidity account for nearly one third of all health care spending on gastrointestinal disease. In addition, despite a decreasing incidence in certain locales, including the United States, gastric cancer remains a leading cause of death worldwide.
The stomach is divided into four major anatomic regions: the cardia, fundus, body, and antrum. The cardia is lined mainly by mucin-secreting foveolar cells that form shallow glands. The antral glands are similar but also contain endocrine cells, such as G cells, that release gastrin to stimulate luminal acid secretion by parietal cells within the gastric fundus and body. The well-developed glands of the body and fundus also contain chief cells that produce and secrete digestive enzymes such as pepsin.