A muscular tube

The Oesophagus „ Conduction of food

and drink
„ Sphincters at top
and bottom

Congenital and mechanical

Histology disorders (1)

„ Non-keratinising
squamous „ Atresia – often with fistula to trachea
epithelium „ Hiatus hernia (presence of stomach in
thoracic cavity) – due to increased
intra-abdominal pressure

…Mechanical disorders (2) Oesophageal varices

„ Achalasia „ Localised dilatation

of lower
{ Failure of relaxation of lower oesophageal veins
oesophageal sphincter (destruction or
„ Secondary to portal
degeneration of nerve plexus) hypertension
{ Similar features in Chagas’ disease (portal vein
(South American trypanosomiasis) thrombosis or
hepatic cirrhosis)
„ Haemorrhage can
be catastrophic

1
Inflammation (oesophagitis) Herpes oesophagitis

„ Acute infective – Herpes virus,

Candida. Both seen most commonly in
immunosuppressed.
„ Ingestion of corrosives
„ Chronic reflux through lower
oesophageal sphincter

Herpes oesophagitis Candida oesophagitis

„ Punched-out ulcers „ Haemorrhagic

mucosa with white
„ Viral intranuclear inclusions
plaques
„ Formation of multinucleated giant cells „ Fungal hyphae and
(cytopathic effect) yeast forms on
microscopy

Consequences of reflux
Reflux oesophagitis oesophagitis

„ Ulceration
„ Stricture
„ Glandular
metaplasia
(Barrett’s
„ Common – often without symptoms oesophagus)
„ Mucosa exposed to acid-pepsin and bile „ Carcinoma
„ Increased cell loss and regenerative activity

2
Barrett’s oesophagus Oesophageal neoplasms
„ Columnar epithelial „ Benign tumours (rare): squamous
cells in lower
oesophagus
papilloma, leiomyoma
„ Variable extent „ Malignant tumours
„ Presence of goblet { Squamous carcinoma
cells “intestinal { Adenocarcinoma
metaplasia”
associated with risk
of progression to Presenting symptom - dysphagia
dysplasia/cancer

Epidemiology of oesophageal
cancer Squamous carcinoma
„ High incidence in
„ Squamous carcinoma commonest Southern Africa (incl.
worldwide Malawi), China, Iran
„ Probably diet related
„ Adenocarcinoma has very different risk (A and B vitamin
deficiency, fungal
factors and is now the commonest contamination) –
type in Europe/N.America tobacco and alcohol
also risk factors
„ Associated with
chronic non-specific
oesophagitis

Squamous carcinoma Adenocarcinoma

„ Often large „ Occurs in lower

exophytic occluding oesophagus
tumours „ Often associated
„ Invasive disease with Barrett’s
preceded by oesophagus
dysplasia and (progresses
carcinoma in situ through dysplasia
to cancer)

3
Clinical course of oesophageal
cancer

„ Grim! (even with best available

resource)
„ Tumours have commonly spread to
regional nodes and/or liver at
presentation
„ No peritoneal lining in mediastinum –
local invasion (heart, trachea, aorta)
often limits surgery