ESOPHAGEAL CANCER TREATMENT
The communication is observed by the cancellated identify of cancer (adenocarcinoma or squamous cell carcinoma vs other types), the initiate of the disease, the generalized condition of the enduring and other diseases present. On the whole, adequate nutrition needs to be assured, and adequate dental tending is vital.
If the enduring cannot enclose at all, a stent may be inserted to keep the passage patent; stents may also assist in occluding fistulas. A nasogastric plaything may be necessary to move intake while communication for the tumor is given, and some patients require a gastrostomy (feeding mess in the skin that gives direct access to the stomach). The latter digit are especially important if the enduring tends to aspirate matter or saliva into the airways, predisposing for aspiration pneumonia.
CURATIVE SURGICAL TREATMENT
This is attempted providing,patient is fit enough to withstand surgery and there is no evidence of distribute beyond esophagus.
1.IN POST CRICOID CARCINOMA
Pharyngolaryngectomy with gastric transposition,colon abnormalcy ,or impressible plaything insertion.
2.IN CARCINOMA OF UPPER THIRD OF OESOPHAGUS
Mckeown threesome stage oesophagectomy may be undertaken ,or the growth may be excised and continuity restored by jejunal or colonic transposition.
3.IN cARCINOMAOf MIDDLE THIRD OF OESOPHAGUS
partial oesophago-gastrectomy with anastomosis above the level of aortic arch.Only most 1/5th of breadbasket is removed.There are two approaches.
(a) RIGHT THORACOTOMY ( Ivor Lewis operation)
it is carried out finished 5th rib bed preceded by a laparotomy to displace breadbasket and to confirm the epilepsy of comprehensive abdominal meatastasis via this approach set for anastomosis is not hampered by aortic arch.
(b)LEFT THORACO-ABDOMINAL (2nd rib ) APPROACH
It is carried out finished a long skin and muscle incision with entry into chest finished 8th rib bed and a immoderate incision in diaphragm for breadbasket mobilization,together with entry finished 5th rib bed for anastomosis.
4. IN CARCINOMA OF LOWER THIRD OF OESOPHAGUS
partial oesophago-gastrectomy finished a thoracoabdominal incision finished 8th rib bed ,extended onto abdomen.About 3/5th of breadbasket is removed ,often together with spleen.Continuity is restored by :
(a) Esophago-gastric anastomosis
(b) Jejunal Roux-en-Y loop.
(c) Transverse colon interposition.
CURATIVE TREATMENT BY RADIOTHERAPY
This is of value in squamous cell carcinoma ,especially in postcricoid region or upper third of esophagus.Aim is to debulk intraluminal growth,so that it is more effective for bulky tumors ,rather than ulcerating lesions.
PALLIATIVE TREATMENT
Aim is to enable the patient to swallow.It is carried out ,if growth is inopeable because of generalized information of patient .or presence of metastases.Various alternatives are:
1. INTERNAL TUBE THROUGH GROWTH
(a)Souttar plaything -Stricture is first dilated and then souttar plaything is passed.
(b)Celestin plaything - Introduced by passing tail of plaything finished stricture into breadbasket at oesophagoscopy ,and then making a small inaugural in breadbasket at laparotomy and pulling the plaything down until its upper end sits snugly over tumor.
(c)Nottingham plaything - settled at endoscopy.
2.PALLIATIVE SHORT CIRCUIT OPERATION.
(a) Palliative oesophago-gastrectomy.
(b) Esophago-jejunostomy with a Roux-en- Y loop.
3.PALLIATIVE RADIOTHERAPY
4.LASER TREATMENT
The communication is observed by the cancellated identify of cancer (adenocarcinoma or squamous cell carcinoma vs other types), the initiate of the disease, the generalized condition of the enduring and other diseases present. On the whole, adequate nutrition needs to be assured, and adequate dental tending is vital.
If the enduring cannot enclose at all, a stent may be inserted to keep the passage patent; stents may also assist in occluding fistulas. A nasogastric plaything may be necessary to move intake while communication for the tumor is given, and some patients require a gastrostomy (feeding mess in the skin that gives direct access to the stomach). The latter digit are especially important if the enduring tends to aspirate matter or saliva into the airways, predisposing for aspiration pneumonia.
CURATIVE SURGICAL TREATMENT
This is attempted providing,patient is fit enough to withstand surgery and there is no evidence of distribute beyond esophagus.
1.IN POST CRICOID CARCINOMA
Pharyngolaryngectomy with gastric transposition,colon abnormalcy ,or impressible plaything insertion.
2.IN CARCINOMA OF UPPER THIRD OF OESOPHAGUS
Mckeown threesome stage oesophagectomy may be undertaken ,or the growth may be excised and continuity restored by jejunal or colonic transposition.
3.IN cARCINOMAOf MIDDLE THIRD OF OESOPHAGUS
partial oesophago-gastrectomy with anastomosis above the level of aortic arch.Only most 1/5th of breadbasket is removed.There are two approaches.
(a) RIGHT THORACOTOMY ( Ivor Lewis operation)
it is carried out finished 5th rib bed preceded by a laparotomy to displace breadbasket and to confirm the epilepsy of comprehensive abdominal meatastasis via this approach set for anastomosis is not hampered by aortic arch.
(b)LEFT THORACO-ABDOMINAL (2nd rib ) APPROACH
It is carried out finished a long skin and muscle incision with entry into chest finished 8th rib bed and a immoderate incision in diaphragm for breadbasket mobilization,together with entry finished 5th rib bed for anastomosis.
4. IN CARCINOMA OF LOWER THIRD OF OESOPHAGUS
partial oesophago-gastrectomy finished a thoracoabdominal incision finished 8th rib bed ,extended onto abdomen.About 3/5th of breadbasket is removed ,often together with spleen.Continuity is restored by :
(a) Esophago-gastric anastomosis
(b) Jejunal Roux-en-Y loop.
(c) Transverse colon interposition.
CURATIVE TREATMENT BY RADIOTHERAPY
This is of value in squamous cell carcinoma ,especially in postcricoid region or upper third of esophagus.Aim is to debulk intraluminal growth,so that it is more effective for bulky tumors ,rather than ulcerating lesions.
PALLIATIVE TREATMENT
Aim is to enable the patient to swallow.It is carried out ,if growth is inopeable because of generalized information of patient .or presence of metastases.Various alternatives are:
1. INTERNAL TUBE THROUGH GROWTH
(a)Souttar plaything -Stricture is first dilated and then souttar plaything is passed.
(b)Celestin plaything - Introduced by passing tail of plaything finished stricture into breadbasket at oesophagoscopy ,and then making a small inaugural in breadbasket at laparotomy and pulling the plaything down until its upper end sits snugly over tumor.
(c)Nottingham plaything - settled at endoscopy.
2.PALLIATIVE SHORT CIRCUIT OPERATION.
(a) Palliative oesophago-gastrectomy.
(b) Esophago-jejunostomy with a Roux-en- Y loop.
3.PALLIATIVE RADIOTHERAPY
4.LASER TREATMENT
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