Classification Esophageal cancers

Esophageal cancers are typically carcinomas which arise from the epithelium, or surface lining, of the esophagus. Most esophageal cancers fall into one of two classes: squamous cell carcinomas, which are similar to head and neck cancer in their appearance and association with tobacco and alcohol consumption, and adenocarcinomas, which are often associated with a history of gastroesophageal reflux disease and Barrett's esophagus. A general rule of thumb is that a cancer in the upper two-thirds is a squamous cell carcinoma and one in the lower one-third is a adenocarcinoma. Rare histologic types of esophageal cancer are different variants of the squamous cell carcinoma, and non-epithelial tumors, such as leiomyosarcoma, malignant melanoma, rhabdomyosarcoma, lymphoma and others.

Treatments of Esophageal Varices

An esophageal varice is a dilated vein in the lower part of the esophagus or in the upper section of the stomach. Commonly caused by liver disease, these swollen blood vessels can burst open and cause extreme bleeding.
Esophageal varices do not always have symptoms before they rupture. For this reason, many medical professionals prefer to screen all patients who have liver diseases, such as cirrhosis of the liver. Cirrhosis is a medical condition in which the liver becomes scarred. With the scarring, comes a decreased capacity of blood flow through the liver. This extra blood is sidetracked to the esophageal area and this increased blood flow is what causes the vein dilation.
Some of the most common symptoms of an esophageal varice are black and tarry stools, visible blood in the stools, a feeling of faintness, paleness, vomiting, or perhaps dark streaks in the stools. For people who have cirrhosis it is recommended that you discuss having a screening to determine if there are signs of varices in the esophagus.
Screening methods include the use of nasogastric tubes to look for signs of active bleeding and the source of the bleeding. If bleeding is recognized at the time of screening, the health care provider will be able to treat the bleeding at that time.
Common treatments include the use of an endoscope to place a rubber band around the swollen and bleeding veins to stop the bleeding. The health care professional might instead opt to inject a clotting medication or a blood vessel restriction medication directly into the vein. A balloon tamponade procedure can be carried out to create pressure on the bleeding vein. This course of action requires a tube to be inserted through the nose and down to the stomach where it is then inflated with air.
If the bleeding is acute, the doctor might need to place the patient on a ventilator to prevent blood from entering the lungs and to protect the patient’s airway. As massive bleeding can cause shock and imminent death, it is vital to get the bleeding under control as quickly as possible.
If the doctor does not see active bleeding during the screening, but observes the varices, treatment can be carried out to prevent bleeding. Medications known as beta blockers reduce the chance of future bleeding from the varices. Rubber banding the veins is another option and can be carried out with only the use of an endoscope.
Surgical means of treatment include a procedure called TIPS in which new associations are created between blood vessels in the liver. When the liver is capable of transporting the blood on its own instead of sending it through the esophagus veins, there is a greatly diminished risk of varices and bleeding.
Treatment of the underlying cause of the esophageal varices is imperative to overcoming the varices itself. When a patient is suffering from severe liver disease, it is recommended that they receive a liver transplant. Without treatment, the prognosis is very poor.
Ref;http://www.esophagealvarices.org/

Overview of Esophageal Varices

Overview of Esophageal Varices-An esophageal varice is a swollen vein in the lower section of the esophagus. The esophagus is the tube that runs from the back of the throat to the stomach. Esophageal varices can also transpire in the top section of the stomach.
Many times esophageal varices are caused by cirrhosis, which is scarring of the liver. If the liver becomes scarred, blood is prevented from passing through the liver and therefore will flow through the esophagus veins. The added blood flow through the esophagus from a scarred liver can result in those esophageal veins ballooning out. The veins can potentially rupture and result in relentless bleeding.
Common symptoms that arise from esophageal varices are black and tarry stools, bloody stools, pale skin, vomiting (perhaps with blood), and a feeling of light-headedness. If the esophageal varices are not bleeding very much there may be only dark streaks in the stool.
Chronic liver diseases such as cirrhosis of the liver are the leading cause of esophageal varices. Because of this, doctors commonly prefer to screen all patients suffering from liver disease for esophageal varices as there are not always clear symptoms.
Screening for esophageal varices includes running a nasogastric tube through the nose and down into the stomach to check for bleeding or signs of bleeding. Esophagogastroduodenoscopy (EGD) is another screening tool, which essentially checks for varices with or without bleeding. EGD tests are routinely ordered for patients who have recently been diagnosed with liver diseases such as cirrhosis.
Because esophageal varices can rupture and bleed profusely, this is the most important aspect of treatment. Profuse bleeding can cause shock and ultimately death if not controlled quickly. If the event of excessive bleeding, medical professionals might place the patient on a ventilator so that the blood does not go into the lungs.
Doctors use an endoscope when they need to inject the varices with a medicine to cause clotting or to rubber band the veins that are bleeding. An endoscope is simply a small tube with a light on the end. Medications can also be delivered that constrict blood vessels as well.
Once the bleeding is under control or in the event bleeding has not yet occurred, health care professionals can treat the esophageal varices in a variety of ways. The most popular treatment is medication. Beta-blockers can be used to prevent future bleeding. Nadolol and propranolol are two drugs that are commonly prescribed for this use.
A medical procedure called TIPS might be carried out in which new links are made between the liver’s blood vessels. This procedure is done with the hope that extra blood flow will not be diverted to the esophageal area. Surgeries to place blood vessel shunts into the veins or to remove completely the esophagus are rarely attempted, as they are quite risky.
Without treatment of some sort, the esophageal varice is likely to return. In extreme cases, liver damage might be so great that a liver transplant might need to be carried out to prevent further harm to the esophagus

Esophageal Varices

Esophageal varices are swollen veins in the mucosa (lining) of the lower part of the esophagus occurring because of portal hypertension due to cirrhosis of your liver. This is often accompanied by varices of the stomach.
( Several causes of Cirrhosis tend to be alcohol liver disease, hepatitis B, C, drug treatments, glycogen storage diseases, autoimmune diseases)
Structure of the top Gastrointestinal tract. (see diagram in Wiki http://en.wikipedia.org/wiki/Gastrointestinal_tract )
Food consumed in the mouth is actually chewed, then enters your Esophagus (muscular pipe covered along with a mucosal membrane ) and is moved alongside through peristalsis on the stomach exactly where digestive function takes place.
Layers of esophagus from inside to exterior -
*  Mucosa – innermost filling commonly of a solid cell layer
*   Submucosa- has blood vessels arteries and also veins, lymphatic vessels and nerves
*   Muscle mass – round and longitudinal muscle
*   Adventitia – outermost lining
Physiology
The superficial veins draining the esophagus drains into the portal vein structure which usually goes by over the liver organ. Whenever cirrhosis (scarr tissue ) happens in the liver it occludes or even squeezes the veins decreasing circulation so there is a back-up of blood causing the veins to utilize a collateral systemic of veins higher than the liver organ. These types of collateral veins then turn out to be dilated and also sent in to the mucosa and also lumen of your wind pipe and abdominal forming problematic veins that are thin and may be destroyed without difficulty causing blood loss in to the lumen of your esophagus.
Symptoms
Result from your complication associated with destroyed vessels and so are the following:
Vomiting large amounts blood – (25 to 30% of persons with varices have got hemorrhage)
Dark colored sticky stools from swallowed blood
Dizziness, some weakness, loss of consciousness,
60% of sufferers having liver disease develop varices therefore signs of persistent liver disease (jaundice, edema, stomach irritation, pruritus, sexual disorder, psychological confusion )
Differential diagnosis connected with blood loss from your Higher gastro intestinal tract
Duodenal Ulcers (35%)
Gastric ulcers (20%)
Mallory weis tears(10%)
Esophgeal Varices(5-11%)
gastric or esophageal carcinoma (6%) unusual reason for considerable upper GI blood loss
Diagnosis
The prognosis is done generally by history ( alcoholic beverages use and also chronic liver illness ) and also the throwing up of massive amount of blood.
Gold standard – Confirmed simply by endoscopy – This procedure can be either diagnostic and therapeutic.
Ref : http://www.esophagealvarices.org/

Esophageal cancer

Esophageal cancer (or oesophageal cancer) is malignancy of the esophagus. There are various subtypes, primarily squamous cell cancer (approx 90-95% of all esophageal cancer worldwide) and adenocarcinoma (approx. 50-80% of all esophageal cancer in the United States). Squamous cell cancer arises from the cells that line the upper part of the esophagus. Adenocarcinoma arises from glandular cells that are present at the junction of the esophagus and stomach.
Esophageal tumors usually lead to dysphagia (difficulty swallowing), pain and other symptoms, and are diagnosed with biopsy. Small and localized tumors are treated surgically with curative intent. Larger tumors tend not to be operable and hence are treated with palliative care; their growth can still be delayed with chemotherapy, radiotherapy or a combination of the two. In some cases chemo- and radiotherapy can render these larger tumors operable. Prognosis depends on the extent of the disease and other medical problems, but is fairly poor
Ref: http://en.wikipedia.org/wiki/Esophageal_cancer