According to medical statistics, up to 90% of cases of malignant gastric neoplasms are squamous cell carcinoma of the esophagus. The prognosis for such a diagnosis directly depends on the stage at which the disease was detected. The best prospects are those who turned to the clinic on time and have the opportunity to resort to the latest methods of treatment.
General categorization
Introduced classification of cases into groups based on the nuances of the structure of atypical cells. Allocate highly differentiated squamous cell carcinoma of the esophagus, as well as cases with moderate and low differentiation. For the first type, the processes of keratinization are more characteristic. The progress of the disease is accompanied by the formation of horn pearls. Gradually, the signs of keratinization become more pronounced: the phenomenon spreads from the periphery to the central part. Polymorphism of cells and nuclei for this form of the disease is characteristic only to a very small extent.
One of the varieties of the describedcategory of pathology - verrucous cancer. Its frequency of occurrence is rather low. This form of neoplasm is characterized by a papillary type of distribution.
Poorly differentiated squamous cell carcinoma of the esophagus is a form of the disease, which is often characterized by a complete absence of keratinization. There may be only slight signs of such a violation. In contrast to the variant considered above, the atypicality of cells is quite significantly expressed; polymorphism is inherent in them. Finally, moderately differentiated esophageal squamous cell carcinoma is a form that is intermediate between those described.
Forms and types
It is known that within the same pathological condition, the appearance of cells of different levels of differentiation is possible. Sometimes patients are diagnosed with a spindle cell scenario for the development of pathology. As the name implies, the neoplasm in this case is formed by cells similar in shape to a spindle. This type of squamous cell carcinoma of the esophagus is similar to sarcoma, which can lead to misdiagnosis. To clarify the phenomenon, it is required to study tissue samples under an electron microscope in order to determine the epithelial nature of the malignant area. Examination of a sufficiently large volume of samples will certainly reveal areas that give an accurate idea of the nature of the disease. For this, light microscopy methods are used.
Another form of invasive squamous cell carcinoma of the esophagus is similar to cutaneous basalioma. This variety is quite rare, it is formed by monomorphic structures close to basaloid ones. Such a tumor is characterized by clear boundaries. It is possible to dilute basaloid cells with horn pearls. In some areas, cysts, strands can form. This allows you to compare the picture of the disease with the basalioma of the mucous type, adenoid.
Shapes and types: rare and not so rare
In some cases, squamous cell carcinoma of the esophagus is formed in foci, accompanied by necrotic processes of the eosinophilic type. A thin layer of atypical structures is observed around such foci. This form is somewhat similar to the basaloid, diagnosed in the anal canal.
The highly differentiated form often develops in fields, complexes, and for a low degree of differentiation, a diffuse type of growth and discomplexation are more characteristic.
Nuances of the case
Studying different theories, summing up statistics, summarizing clinical data on the treatment of squamous cell carcinoma of the esophagus, scientists have found that the level of response to radiation therapy usually depends on the degree of differentiation inherent in a particular case. True, the scientific works published at the present time are quite contradictory, there are no reliable and indisputable data on the typical course of the disease.
It has been established that radiation therapy for squamous cell carcinoma of the esophagus leads to strong changes in tumor structures. There is a possibility of complete death of atypical cells. Fields of fibrosis are formed, separate foci -lymphoplasmacytic infiltrate, and the surface turns into a necrotic area. In many cases, the fibrous area becomes the area of localization of horny masses, granulomas, dystrophic cells, which are characterized by hyperchromic nuclei. In some cases, patients who have undergone radiation treatment of squamous cell carcinoma of the esophagus have one of two types of eosinophilic cytoplasm: homogeneous, with vacuoles.
If in the future atypical cells begin to grow again, the areas preserved from the first episode have numerous mitotic figures, and look anaplastic when examined.
Curious information and important nuances
From medical statistics it is known that squamous cell carcinoma of the esophagus (keratinizing and non-keratinizing) is more likely to develop in people of advanced age. Among patients of clinics, on average, there are more men. In the age group under 30, malignant neoplasms in the esophagus are extremely rare. The cause of the cancer process is the malignancy of he althy cells. The disease is more often localized in the lower part of the esophagus or the middle part of the organ.
The first symptom that allows you to suspect something is wrong with your he alth is the complication of swallowing. Gradually, the condition progresses, and at a late stage, squamous cell carcinoma of the esophagus (with and without keratinization) becomes the reason for the inability to take even soft food. Against the background of such a phenomenon, the patient loses a lot of weight.
Development and dissemination process
At the first stage, the disease does not manifest itself as significant symptoms, so the patient is unlikely to suspect he alth problems. It is possible to detect squamous cell carcinoma of the esophagus (non-keratinizing, keratinizing) only if a person undergoes a preventive examination or came to the clinic with other diseases, during the clarification of which he was sent for a specialized check. Instrumental techniques to help establish the presence of atypical cells: CT, ultrasound, endoscopy.
In squamous cell carcinoma of the esophagus, survival is directly related to the level of progress of the condition. The worst prognosis is for people who seek help in the fourth stage: there are no known cases that would end in a complete cure. To clarify the level of development, samples of degenerate tissues are taken for histological analysis. In the last stages, the disease spreads to nearby tissues and organs - this is characteristic of all malignant processes. Possible damage to the trachea, vascular system, bronchi. Metastases are detected not only in the sternum, but also in distant parts of the body.
Classes and varieties
The system of division into low-, high-, moderately differentiated squamous cell carcinoma of the esophagus (with and without invasion) was indicated above. In addition, all cases are usually classified as exophytic, when spread occurs in the lumen of the organ, and endophytic, when atypical cells spread in the thickness of the organ or submucosal layer. With mixed developmentdiseases simultaneously affect all layers of the walls of the esophagus. This form is characterized by the rapid appearance of numerous ulcers and an active necrotic process.
Best survival prognosis for superficial esophageal squamous cell carcinoma. A tumor is an erosive area or plaque formed on the esophageal wall. Such a neoplasm does not grow to a very large size. The prognosis for the deeply invasive form is much worse. Malignancy covers deep tissues in the esophagus. In the pictures, such a tumor is similar in shape to a fungus or is formed in the form of a deep ulcer. The process is characterized by the rapid spread of metastases to the respiratory and cardiac systems.
Types and cases: nuances of forms
Studying a neoplasm using modern instruments usually allows you to get a picture of the surrounding growth. Typically, cancer cells form a ring on the inside of the esophagus. Gradually, malignancy covers more and more large areas, the lumen of the organ narrows, and a typical clinical picture is formed.
In some cases, cancer develops in the form of a polyp.
It has been established that in women the disease often begins to progress in the lower part of the esophagus, gradually growing upwards. Men are more likely to form abnormal cells in the junction of the esophagus to the stomach.
Cornation: yes or no?
The non-keratinized form is usually accompanied by a malfunction of the digestive system due to a decrease in the lumen of the esophagus. Problems accompany the process of swallowing - this applies not only to eating,but also adventures along the gastrointestinal tract of saliva. From time to time the patient is characterized by regurgitation.
The keratinizing type of the disease transforms the mucous membranes of the esophagus. The cells become horny, the walls become dry, the clinical picture is significantly aggravated. The neoplasm grows rapidly, but the slow formation of the vascular wall leads to a lack of cellular nutrition. This provokes necrotic areas. Endoscopic examination reveals them in the form of ulceration zones.
Relentless statistics: what awaits the patient?
Detection of the disease in the primary stages is associated with the best chances of a positive outcome. The patient is shown complex therapy. Survival in the assessment of five years on average is about 80%. In the future, it is possible to continue working if the profession does not require significant physical effort.
If the cancer is found at an advanced stage, studies can detect distant metastases, treatment is possible only with great difficulty. Even the use of the most effective and modern methods does not always help to achieve at least some significant progress.
Where did the trouble come from?
So far, doctors have not been able to find out all the reasons that can provoke squamous cell carcinoma of the esophagus. As a rule, the disease develops if a person is affected by several carcinogenic factors. The more numerous this group, the more likely tissue malignancy.
Statistics show that squamous cell carcinoma of the esophagus is more often found in smokers with decades of experience. Tobacco is rich in carcinogens,accumulating on the esophageal walls and provoking atypical cell changes. On average, the risk of cancer with a long history of smoking is four times greater than in other groups.
With no less dangers associated with frequent and heavy drinking. Such drinks burn the mucous membranes of the esophagus, provoking the growth of the epithelium, which can go according to an atypical scenario. The incidence of squamous cell malignancy in chronic alcoholics is 12 times higher than among other groups.
Factors and nuances: what matters?
With great dangers of squamous cell carcinoma is associated with malnutrition and irrational food intake. Frequent use of s alty, hot, pickled, overly spicy - all this can cause a malignant process. Dishes rich in moldy fungi negatively affect the walls of the esophagus. A negative factor is the lack of fresh plant products. All these features of the daily diet are most typical for residents of the Central Asian region and the Far East, as well as some Siberian regions. Statistics confirm that among these people the incidence of esophageal cancer is higher than in other areas, dozens, and sometimes even hundreds of times.
Another nuance that can become an impetus for malignancy is a burn on the surface of an organ, provoked by the ingress of too hot a substance or a chemically active compound. Sometimes the burn that causes cancer is chronic damage due to frequent use as food.too hot food. There are cases when, against the background of accidental penetration of concentrated alkali into the gastrointestinal tract, a malignant neoplasm was detected in a person after a few years.
Risk groups and dangers
More likely tissue malignancy with a lack of vitamins in the body. With beriberi, the mucous layers do not receive retinol and tocopherol, without which normal functioning and development is impossible. These vitamins form the protective layer of the esophagus. If their shortage is observed for a long time, gradually the cellular structures are reborn.
It is known that those whose close relatives have had oncology are more likely to get cancer. Hereditary predisposition is a factor that must be taken into account without fail. It has been established that the mutation of the p53 gene causes the generation of abnormal protein structures that inhibit the natural protective functions of the esophageal cells. Against the background of such a process, the probability of malignant degeneration is significantly higher.
Diagnoses and dangers
It is known that in the predominant case in patients with squamous cell carcinoma of the esophagus, infection with the papillomavirus is detected. Scientists suggest that HPV may be one of the triggers for malignancy.
Esophagitis is suspected as a precursor to cancer. The pathological condition leads to regular ingestion of hydrochloric acid into the esophagus. This negatively affects the mucous membrane, irritates it and can provokecell transformation. Esophagitis is often observed against the background of excess weight and gastric diseases. It can lead to a complication known medically as Barrett's esophagus. This term describes the progress of the disease with the degeneration of multilayer epithelial structures into cylindrical ones.
First manifestations
It is possible to suspect that it is necessary to visit a doctor if a person loses weight dramatically, which is accompanied by problems with swallowing. Possible cachexia. The patient feels weak. Dysphagia is first observed when trying to eat solid food, and stabilization can be achieved if the products are actively washed down with liquid. Gradually, the condition worsens, there is difficulty in eating cereals and soups. Dysphagia is the main and constant manifestation of a malignant neoplasm in the esophagus. Gradually it becomes more pronounced.
