Neoplasm is a pathological process as a result of which new tissues are formed with changes in the genetic apparatus of cells, which entails a failure in the regulation of their differentiation and growth. New growths are called tumors and are divided into benign and malignant. Tumors of the esophagus have pronounced symptoms, upon observation of which the patient should consult a doctor who will diagnose and prescribe treatment.

Pathologies in the esophagus with the formation of new tissue may portend cancer.

Symptoms

The formation, which appeared in the patient quite recently, is small in size, which means the disease does not manifest itself. As tumors grow, various symptoms are observed. Thus, in the first stages, esophageal tumors are accompanied by the following symptoms:

• loss of appetite;
• there is a sharp decrease in body weight;
• feeling weak;
• there is constant fatigue.

Symptoms, at first glance, do not indicate the occurrence of a serious change in the body and the patient does not attach any importance and is in no hurry to consult a doctor, but with the development of the tumor, it acquires other signs of the disease:

• the process of swallowing food becomes more difficult due to narrowing of the esophagus;
• nausea, vomiting, and bad breath appear;
• there is pain in the chest area, which occurs due to pinched nerve endings;
• tumors are accompanied by shortness of breath, cough, pain in the chest, the voice may become hoarse and the body temperature may rise.

Diagnostic methods

Diagnostics will allow the doctor to determine the location and size of the newly formed tissue, to determine whether it is malignant or benign. Benign tumors of the esophagus are diagnosed using X-ray examination and esophagoscopy. Malignant tumors of the esophagus are diagnosed by X-ray and endoscopic methods, to which there is an addition in the form of a morphological study of samples of changing areas of the esophageal mucosa.

X-rays examine the functionality of swallowing and determine the location of the disorder (in the esophagus or pharynx). If the x-ray has diagnosed a malfunction of the esophagus, then the next steps will be to identify irritating foods. Using radiography, you can find out about the location of the tumor, its size and the general condition of the affected organ.

In the esophagus, new changed tissues can be diagnosed using the endoscopic method, which is most popular in the first stages of the disease, when the symptoms are little noticeable.

This diagnostic method is based on a visual examination, taking part of the esophageal mucosa for the remaining necessary studies. Tumors can be diagnosed using ultrasound or computed tomography.

Kinds

• Before starting treatment for formations in the esophagus, it is important to correctly diagnose them. Thus, the classification of tumors is as follows:
• according to location they are distinguished: at the bottom, in the middle and at the top of the organ;

by structure: originates from glands that produce mucus and from squamous epithelial cells. Tumors of the esophagus are divided into benign and malignant. Benign ones do not pose a threat to human life, provided they are removed in a timely manner; if such new altered tissues are left unnoticed, they will take a malignant form.

Malignant tumors are characterized by the growth of metastases and pose a threat to human life.

Benign

Esophageal tumors can be benign

• A benign tumor of the esophagus is a neoplasm that is formed from various layers of the walls of the stomach and is characterized by slow development without genetic changes in cells. Thus, benign formations have mucosal, submucosal, subserosal and muscular localizations. The classification of benign pathological tissue growths is as follows:
• endogastric;
• intramural;

exogastric.

• Benign tumors of the esophagus have the following types:
• Esophageal cyst. The cyst often spreads in the lower part of the organ and is congenital in nature. It looks like a thin-walled formation and contains a transparent liquid with a yellow tint.
• Xanthoma. Gastric xanthoma occurs as a result of fat deposition in the mucous membrane. It is observed in elderly people with atherosclerosis in the vessels, in patients with an atrophic form of gastritis and diabetes mellitus. Gastric xanthoma ranges in size from a millimeter to one and a half centimeters and is yellow or white-yellow in color.
• Abrikosov tumor or granular cell myoblastoma. Abrikosov's myoblastomyoma ranges in size from a centimeter to four. Localized in the submucosal layer of the bronchi and trachea, it has rounded large cells with fuzzy contours and fine-grained cytoplasm. Abrikosov's myoblastomyoma is removed by endoscopy in every second patient and in 50% of cases requires repeated surgical intervention.

Malignant

Malignant neoplasms are tumors that have completely or partially lost the ability to differentiate. Malignant tumors are often observed in people over 60 years of age. Symptoms of malignant neoplasms of the esophagus are as follows:

At the late stage of the disease, general weakness, poor appetite, fatigue, dry mouth, dry eyes and nose, sleep disturbances, and increased sweating are observed. In addition to these symptoms, the patient’s body temperature rises, anemia is diagnosed, immunity decreases and nausea with vomiting appears.

Malignant tumors come in four types: lymphoma, carcinoma, esophageal cancer and leiomyosarcoma, and have four stages, the last of which is characterized by a tumor of various sizes and the growth of any type of individual metastases. Doctors cannot name the leading cause of malignant tumors; they only identify contributing factors. These include:

• anemia;
• narrowing of the esophagus;
• eating disorder;
• gastroesophageal reflux;
• excessive alcohol consumption;
• hernia;
• hereditary malignancies.

Treatment

Treatment methods for malignant and benign neoplasms are selected individually for each patient. Treatment of the tumor-like area is of the following types:

• surgical removal of a separate area with a tumor;
• intubation, which is based on the introduction of a special tube into the esophagus, which can improve swallowing and increase narrowing;
• radiotherapy is necessary if there is a tumor on the outside of the organ;
• laser therapy is used when it is necessary to remove a tumor in several cycles;
• Chemotherapy can shrink the tumor area and has the ability to stop the development of cancer.

Epiphrenic diverticula are also asymptomatic in most patients, but can manifest as pain in the lower part of the sternum, aerophagia, nausea, vomiting, reflex shortness of breath, palpitations, bronchospasm, symptoms of esophageal compression and cardiospasm. The course of the disease is slow, without significant progression.

Zenker's diverticula can be complicated by the development of diverticulitis, which in turn can cause phlegmon of the neck, mediastinitis, the development of an esophageal fistula, and sepsis. Regurgitation and aspiration of the contents of the diverticulum lead to chronic bronchitis, repeated pneumonia, and lung abscesses. Bleeding from the eroded mucous membrane of the diverticulum, the development of polyps in it, and malignancy of its wall are possible.

With prolonged retention of food masses in epibronchial and epiphrenic diverticula, complications may occur: diverticulitis, mediastinal abscess with a breakthrough into the bronchus, esophagus, pericardium and other mediastinal organs, massive bleeding. Chronic diverticulitis predisposes to cancer. Pharyngeal-esophageal diverticula can sometimes be detected by inspection and palpation of the neck. The main method for diagnosing diverticula of the esophagus is a contrast X-ray examination, which establishes the presence of a diverticulum, the width of the neck, the duration of barium retention in it, the degree of obstruction of the patency of the esophagus, signs of the development of a polyp and cancer in the diverticulum, the formation of esophageal-bronchial and esophageal mediastinal fistulas. Endoscopic examination makes it possible to determine the presence of a diverticulum, detect ulceration of its mucous membrane, the presence of bleeding, and diagnose a polyp or cancer in the diverticulum. The study must be carried out very carefully due to the possibility of perforation of the diverticulum. Treatment for small diverticula, the absence of complications, and absolute contraindications to surgical treatment is carried out with conservative therapy aimed at preventing the retention of food masses in the diverticulum and reducing the possibility of developing diverticulitis. Food must be complete, mechanically, chemically and thermally gentle. Patients are advised to eat well-chopped food. After eating, they should drink a few sips of water and take a position that helps empty the diverticulum. With large diverticula, it is sometimes necessary to wash the diverticulum cavity. Indications for surgical treatment of esophageal diverticula: complications (perforation, penetration, bleeding, esophageal stenosis, cancer, development of fistulas), large diverticula complicated by at least short-term retention of food masses in them, long-term retention of food in the diverticulum, regardless of its size. Depending on the location of the diverticulum, the surgical approach is chosen: for pharyngoesophageal - cervical, for epibronchial - right-sided transthoracic, for epiphrenic - left-sided transthoracic. Diverticulectomy is used: the diverticulum is isolated from the surrounding tissues up to the neck, a myotomy is performed, it is excised and the hole in the wall of the esophagus is sutured. In case of a significant muscle defect or atrophy of the muscle fibers of the esophagus, plastic restoration of its wall is performed using a flap of the diaphragm and pleura. Invagination is used only for small diverticula. Mortality after surgery is 1–1.5%.

Benign tumors and cysts of the esophagus

Benign esophageal tumors and cysts are rare. Pathological anatomy: tumors in relation to the wall of the esophagus can be intraluminal (polyp-shaped) and intramural (intramural). Based on the histological structure, tumors are divided into epithelial (adenomatous polyps, papillomas) and non-epithelial (leiomyomas, rhabdomyomas, fibromas, lipomas, hemangiomas, neuromas, chondromas, myxomas, etc.). Intraluminal tumors are most often located in the proximal or distal part of the esophagus, intramural tumors are located in the lower two-thirds of it. Of the intramural benign tumors of the esophagus, the most common type is leiomyoma, which develops from smooth muscle fibers.

The second most common place among benign intramural formations of the esophagus is occupied by cysts (retention, bronchogenic, enterogenic). Cysts are thin-walled formations containing a light, viscous fluid. The wall of the cyst consists of fibrous tissue mixed with smooth muscle fibers and cartilage. The inner surface of the wall of a bronchogenic cyst is lined with ciliated epithelium, while an enterogenic cyst is lined with columnar or squamous epithelium. Retention cysts are located in the submucosal layer of the esophagus and are formed as a result of blockage of the gland ducts. They never reach large sizes.

Clinic and diagnosis: benign tumors and cysts of the esophagus grow slowly, do not cause clinical symptoms for a long time and are discovered by chance during an X-ray examination of the gastrointestinal tract. Their clinical manifestations depend on the level of localization, size and presence of complications (ulceration, inflammation, pressure on neighboring organs). The most common symptom is periodic dysphagia that slowly increases over many years. More often it is observed with intraluminal large tumors with a long stalk. With intramural tumors that surround the esophagus, dysphagia can be permanent; sometimes patients report pain, a feeling of pressure or fullness behind the sternum, and dyspeptic symptoms. With tumors of the cervical esophagus that have a long stalk, tumor regurgitation and the development of asphyxia may occur. In case of ulceration of the polyp or damage to the mucous membrane of the esophagus, stretched over. large intramural tumor, bleeding is possible. Esophageal cysts can fester. Due to tumor compression of the mediastinal organs (trachea, bronchi, heart, vagus nerves), cough, shortness of breath, cyanosis, palpitations, pain in the heart area, arrhythmia and other disorders may occur. Malignant degeneration of benign tumors and esophageal cysts is possible.

The diagnosis of a benign tumor of the esophagus is made based on an analysis of the clinical picture of the disease, X-ray data and esophagoscopy. Benign tumors of the esophagus are characterized by the following radiological signs: clear, even contours of the filling defect located on one of the walls of the esophagus, preservation of the relief of the mucous membrane and elasticity of the walls of the esophagus in the area of ​​the defect, a clear angle between the wall of the esophagus and the edge of the tumor (the “visor” symptom). During a cinematic examination, a benign formation of the esophagus moves upward during swallowing along with the wall of the esophagus. To exclude external compression of the esophagus by a neoplasm emanating from the mediastinum or by an abnormally located large arterial vessel, pneumomediastinography and aortography are used. All patients with benign formations of the esophagus are recommended to undergo esophagoscopy to clarify the nature of the formation, its location and extent, and the condition of the mucous membrane. Esophagoscopy allows one to identify an intraluminal tumor, examine its base, and ensure that there is no rigidity in the walls of the esophagus. Ulceration of the mucous membrane in benign intramural tumors and esophageal cysts is rarely observed. A biopsy can be performed only in the presence of destruction of the mucous membrane and in cases of intraluminal neoplasms. Treatment: for benign tumors, due to the possibility of bleeding, malignancy, compression of surrounding organs, and for cysts of their suppuration and perforation, surgical treatment is indicated. Small tumors on a thin stalk can be removed through an esophagoscope using special trenches and electrocoagulation. For intraluminal tumors on a wide base, they are excised with a section of the esophageal wall. For intramural tumors and cysts of the esophagus, it is almost always possible to enucleate them without damaging the mucous membrane. The long-term results of the operations are good.

Esophageal carcinoma

Cancer accounts for 60–80% of esophageal diseases. The share of other malignant lesions (sarcoma, melanoma, malignant neuroma, etc.) accounts for about 1%.

Among all malignant diseases, esophageal cancer in the USSR is in sixth or seventh place. The disease most often develops at the age of 50–60. Men under the age of 60 are more likely to get sick, and in older age groups – women. Mortality from esophageal cancer ranks third after stomach cancer and lung cancer.

The incidence of esophageal cancer varies in different parts of the world. On the territory of the USSR, high incidence is observed in Turkmenistan, Kazakhstan, and Uzbekistan. The unevenness of morbidity can be explained by the peculiarities of the population’s diet (food composition, various admixtures to it, cooking features), as well as the geological and mineralogical characteristics of the soil and water.

Etiology and pathogenesis: chronic inflammation of the mucous membrane due to mechanical, thermal or chemical irritation plays an important role in the development of esophageal cancer. Traumatization of the mucous membrane of the esophagus by poorly chewed food masses, food containing small bones, very hot fatty foods, as well as excessive consumption of hot spices and alcohol, smoking can contribute to the occurrence of chronic nonspecific esophagitis, which is a precancerous disease.

The development of esophageal cancer was noted in patients with achalasia cardia (4–7%), especially with a significant expansion of the esophagus and prolonged stagnation of poverty in it, as well as in patients with esophageal diverticula, hiatal hernias and congenital short esophagus due to the presence of chronic peptic esophagitis Long-term non-healing peptic ulcers of the esophagus (especially Barrett's ulcer; see “Peptic ulcers of the esophagus”) are always suspicious of the possibility of malignancy. One of the factors leading to the occurrence of esophageal cancer is cicatricial strictures after chemical burns. Post-burn esophageal strictures are considered a precancer. The appearance in these patients of long-term non-healing ulceration, diverticulum-like protrusions, fistulas, rapid weight loss are indications for removal of the scarred esophagus. Exclusion of the esophagus during total plastic surgery of the colon in case of a burn stricture eliminates the possibility of malignancy due to the elimination of esophagitis. In the presence of esophageal polyps, there is always a real danger of their degeneration , so the esophageal polyp must be removed.

A precancerous disease is considered to be sideropenic syndrome (Plummer–Vinson syndrome), which is manifested by hypochromic anemia, achlorhydria, atrophy of the mucous membranes, and later hyperkeratosis of the mucous membrane of the oral cavity, pharynx and esophagus. It is believed that this disease can occur with insufficient iron and vitamins in the diet , especially vitamins B2 and C. The group of obligate precancers includes papillomas of the esophagus. Patients with this disease are subject to observation with repeated biopsies for microscopic diagnosis.

Pathological anatomy: esophageal cancer develops more often in places of physiological narrowing: the mouth of the esophagus, at the level of the trachea bifurcation, above the physiological cardia. In terms of the frequency of cancer lesions, the mid-thoracic region is in first place (in 60%) - at the level of the aortic arch and the left main bronchus, in second in place - the lower thoracic and abdominal sections of the esophagus (in 30%), in the third - cervical and upper thoracic (in 10%) According to the macroscopic picture, three main forms of esophageal cancer are distinguished, nodular cancer (fungal, papillomatous), ulcerative, infiltrating. There are mixed forms of growth.

Nodular forms account for about 60% of esophageal cancers. These tumors have exophytic growth, are represented by growths similar to cauliflower, and are darker in color than the normal mucous membrane. The tumor is easily injured, subject to decay and constantly bleeds. Tumor infiltration extends to the submucosal and muscular membranes. With the disintegration and ulceration of nodes, the macroscopic picture differs little from the picture of ulcerative cancer. The ulcerative type of esophageal cancer occurs in approximately 30% of patients. In the initial stage of the disease, it is a nodule in the thickness of the mucous membrane, which quickly undergoes ulceration. The tumor grows predominantly along the esophagus, affecting all layers of its wall and spreading to surrounding organs and tissues. The edges of the resulting ulcer are dense, the bottom is covered with a dirty grayish coating. The tumor metastasizes early to regional and distant lymph nodes. Cancerous lymphangitis often develops in the wall of the esophagus 5–6 cm from the edge of the tumor.

The infiltrative form of esophageal cancer accounts for about 10%. The tumor develops in the deep layers of the mucous membrane, quickly affects the submucosal layer and spreads mainly around the circumference of the esophagus. As the tumor grows, it engulfs all layers of the esophageal wall and obstructs its lumen. The length of the tumor rarely occupies more than 3–4 cm, is characterized by abundant development of stroma, and slowly metastasizes. Subsequently, ulceration of the tumor and the development of perifocal inflammation occurs. Suprastenotic dilatation of the esophagus in cancer is rarely significant, since the tumor develops in a relatively short period of time.

The spread of esophageal cancer occurs through direct germination, lymphogenous and hematogenous metastasis.

The tumor can spread up and down the esophagus, grow through all layers of its wall, and compress neighboring organs. A relatively late complication is the growth of the tumor into neighboring organs, which can lead to the formation of a fistula between the esophagus and the trachea or bronchus, the development of pneumonia, gangrene and suppurative processes in the lungs and pleura, and fatal bleeding when the tumor grows into the aorta.

Dissemination of cancer cells through the lymphatic vessels in the wall of the esophagus can occur 10–15 cm from the visible border of the tumor. This “cancerous lymphangitis” is more common when the process is localized in the upper and middle third of the esophagus. Along with the intramural spread of the tumor, superficial and deep lymph nodes are involved in the process. Tumors located in the cervical and upper thoracic esophagus metastasize mainly to the mediastinal, supraclavicular and subclavian lymph nodes. Cancer of the lower third of the esophagus metastasizes to the lymph nodes located around the esophagus and cardia, retroperitoneal lymph nodes, along the celiac artery and its branches to the liver. When the tumor is localized in the midthoracic esophagus, metastases spread to the peritracheal, hilar and lower esophageal lymph nodes. However, with cancer of the midthoracic esophagus, the tumor can metastasize to the lymph nodes located below the diaphragm in the cardia region, along the celiac artery and its branches. That is why some surgeons recommend that surgery for esophageal cancer always begin with laparotomy and revision of the abdominal organs and retroperitoneal space.

In case of esophageal cancer, metastases are observed in the parietal and visceral pleura. Distant metastases most often occur in the liver, less often in the lungs, bones and other organs.

Hematogenous spread of carcinoma occurs in the late stage of the disease. Histologically, the vast majority of patients with esophageal cancer are squamous cell. Less common are adenocarcinomas (8–10%), which develop from islands of the gastric mucosa ectopic into the esophagus or from cardiac glands present in the lower esophagus. Rarely, colloid cancer develops. Other malignant tumors of the esophagus include adenoacanthoma, consisting of glandular and squamous elements, and carcinosarcoma (a combination of cancer and sarcoma).

The international classification of esophageal cancer provides for tumor characteristics using the TNM system.

T – primary tumor TIs – preinvasive carcinoma.

TO – no manifestation of the primary tumor.

T1 – the tumor involves less than 5 cm of the length of the esophagus, without causing narrowing of the lumen. There is no circular lesion of the walls of the esophagus. There is no extraesophageal spread of the tumor.

T2 – tumor more than 5 cm along the length of the esophagus. A tumor of any size that causes a narrowing of the esophagus. A tumor that spreads to all the walls of the esophagus. There is no extraesophageal spread of the tumor.

T3 – the tumor spreads to neighboring structures. N – regional lymph nodes NO – regional lymph nodes are not palpable. N1 – mobile lymph nodes on the affected side. N1a – enlarged lymph nodes do not contain metastases. N1b – enlarged lymph nodes contain metastases. N2 – mobile lymph nodes on the opposite side or bilateral. N2a – enlarged lymph nodes do not contain metastases. N2b – enlarged lymph nodes contain metastases. N3 – fixed lymph nodes.

M – distant metastases MO – no manifestations of distant metastases to lymph nodes or other organs.

M1 – there are distant metastases.

M1a – metastases to distant lymph nodes. M1b – other distant metastases.

Clinic and diagnosis: in the clinical manifestation of esophageal cancer, three groups of symptoms can be distinguished: 1) local, depending on damage to the walls of the esophagus; 2) secondary, arising as a result of the spread of the process to neighboring organs and tissues; 3) general.

The onset of esophageal cancer is asymptomatic. The latent period can last 1–2 years. Dysphagia (in 70–98% of patients) is the first symptom of the disease, but essentially it is a late symptom that occurs when the lumen of the esophagus is closed by a tumor by 2/3 or more, while 60% of patients have metastases in the lymph nodes. Cancer is characterized by a progressive increase in esophageal obstruction, which develops quickly in some patients, and slowly in others (within 1 1/2–2 years). Impaired patency of the esophagus is associated not only with a narrowing of its lumen by the tumor, but may be due to the development of perifocal inflammation, the occurrence of esophageal spasm when the tumor affects the intramural nerve plexuses. More often, spastic phenomena are observed with endophytic tumors. In the initial stage of the disease, dysphagia occurs when swallowing dense or insufficiently chewed food. Patients feel as if it is “sticking” to the wall of the esophagus or a temporary delay at a certain level. A sip of water usually eliminates these phenomena. Subsequently, even well-chewed food ceases to pass through, and patients are forced to take semi-liquid and liquid food; dysphagia becomes permanent and occurs even when drinking liquid. Sometimes, after a persistent period of dysphagia, there is an improvement in the passage of food through the esophagus, associated with the disintegration of the tumor. The occurrence of dysphagia may be preceded by sensations of a foreign body in the esophagus that appear when swallowing solid food, a feeling of “scratching” behind the sternum, and pain at the level of the lesion.

Pain (in 33%) is a common symptom of esophageal cancer. Pain behind the sternum of a dull, pulling nature occurs during meals and can radiate to the back, neck, and left half of the chest. The mechanism of pain is different. Chest pain that occurs during eating is caused by food traumatizing the inflamed wall of the esophagus near the tumor and esophagospasm. Dull, cramping pain during eating occurs when the esophagus is obstructed by a tumor. In this case, the appearance of pain is associated with increased contraction of the esophageal wall, aimed at moving food through the narrowed area. Constant pain, independent of food intake or worsening after eating, is caused by tumor growth into the tissues and organs surrounding the esophagus, compression of the vagus and sympathetic nerves, and the development of periesophagitis and mediastinitis. The cause of pain may be metastases in the spine.

Regurgitation of food and esophageal vomiting (in 23%) occur with significant stenosis of the lumen of the esophagus and accumulation of food above the narrowing site. Vomit consists of undigested food, saliva and mucus, sometimes mixed with blood. Some patients artificially induce vomiting to relieve the feeling of fullness behind the sternum and pain that appears while eating. Bad breath is noted due to the decomposition of food lingering over the tumor or the disintegration of the tumor itself. Nausea and belching are observed in patients with tumor infiltration of the walls of the esophagus in the area of ​​the physiological cardia

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Benign tumors of the esophagus

What are Benign esophageal tumors -

Benign tumors of the esophagus are quite rare. They make up only 0.5-5% of all tumor lesions of the esophagus. Most often, various benign tumors of the esophagus occur in people aged 25-60 years, predominantly affecting men. Currently, the etiology of these diseases is unknown, with the exception of some types of esophageal cysts, which are congenital malformations.

Based on their origin, epithelial and non-epithelial benign tumors and cysts are distinguished.

According to the form of growth, intraluminal tumors are distinguished - adenomas, papillomas, fibromas, lipomas and intramural - other types of tumors.

Symptoms of Benign esophageal tumors:

Clinical manifestations of the disease are determined by the form of tumor growth, its size and location. To a much lesser extent, the clinical picture of the disease is related to the histological structure. It should be noted that there is no strict parallelism between the size of the tumor and the severity of the clinical picture. Sometimes even large tumors remain asymptomatic for a long time and are an accidental finding during X-ray, endoscopic examination of the esophagus or at autopsy. Less commonly, with small tumors, patients complain of quite severe spastic pain in the chest or in the epigastric region, dysphagia, which is associated with functional disorders of esophageal motility and esophagospasm.

The form of tumor growth has a more significant influence on the clinical picture of the disease. With intraluminal tumors of the esophagus, the leading symptom of the disease is dysphagia, usually mild or moderate. The increase in the degree of dysphagia occurs slowly as the tumor itself grows. The second most common symptom is dull pain of moderate intensity, localized behind the sternum. The pain intensifies when eating. Other clinical manifestations of intraluminal tumors include nausea, drooling, regurgitation, and sensation of a foreign body behind the sternum. With large intraluminal tumors, dysphagia can be quite pronounced, vomiting often occurs, and patients lose weight. However, significant disturbances in the general condition of patients usually do not occur. Complete obstruction of the esophagus due to benign intraluminal tumors, as a rule, does not occur.

Intraluminal tumors are most often localized in the upper third of the esophagus. Often adenomas, papillomas and lipomas are located on a rather long stalk and, when vomiting, can migrate from the esophagus into the lumen of the larynx, causing asphyxia, sometimes even fatal.

Intramural tumors are usually localized in the lower half of the esophagus and remain asymptomatic for a long time. Only when the tumor reaches a significant size does dysphagia occur, which is the most common symptom of the disease. Complete obstruction of the esophagus, as a rule, does not occur, except in cases where the tumor surrounds the esophagus circularly.

Among other clinical manifestations of intramural tumors, the most common symptoms are dull pain behind the sternum or in the area of ​​the xiphoid process, nausea, and loss of appetite. The general condition of patients is usually not disturbed. With predominantly extraesophageal growth of the tumor, and with its large size, symptoms associated with compression of the mediastinal organs may be observed - constant dull pain in the chest, dry cough, shortness of breath, cardiac arrhythmia, hoarseness.

Leiomyoma. It is the most common benign tumor of the esophagus (60-70% of all benign neoplasms). Leiomyomas usually originate from the muscular lining of the esophagus, much less often from the lamina propria of the mucous membrane or the smooth muscle elements of the vascular wall. The tumor spreads in the thickness of the esophageal wall between the longitudinal and circular muscle layers; in some cases, circular growth of leiomyomas is observed. The mucous membrane over the tumor is preserved. Leiomyoma has a well-defined connective tissue capsule. When the tumor ulcerates, a defect in the mucous membrane of the esophagus occurs.

Leiomyomas are localized predominantly in the thoracic part of the esophagus (in more than 90% of patients), much less often (in 7%) - in its cervical part. Multiple esophageal leiomyomas are sometimes observed. Most often, leiomyomas reach sizes of 5-8 cm, although there are reports of giant leiomyomas reaching a length of 15-17 cm and a weight of over 1 kg.

This tumor is 3 times more common in men, usually aged 20-50 years. In women, leiomyomas usually appear in the sixth decade of life.

For a long time, leiomyomas are asymptomatic. When the tumor is significant or has a circular growth, the disease occurs with symptoms of dysphagia (which happens in more than half of the patients). Less common is “compression syndrome” associated with compression of the mediastinal organs. When the tumor disintegrates and the mucous membrane covering it ulcerates, bleeding occurs, which, as a rule, is not profuse.

Esophageal cysts. They occupy the second place in frequency among all benign tumors of the esophagus. Their most common location is the lower part of the esophagus. Most esophageal cysts are congenital. They are thin-walled formations containing a transparent yellowish or opalescent liquid. The outer wall of the cyst is represented by fibrous and smooth muscle tissue, the inner wall is represented by squamous or cylindrical, ciliated (with bronchogenic cysts) epithelium. The contents of the cyst are determined by the morphological structure of its inner shell. It can be serous, mucous, serous-purulent, jelly-like. In all cases, desquamated epithelial cells are detected in the contents of the cyst. If the inner layer of the cyst is represented by the gastric mucosa, quite often its contents acquire a hemorrhagic or brown tint. In these cases, due to the active secretion of gastric juice, the cyst can quickly increase in size, causing compression of the vital organs of the mediastinum with characteristic clinical symptoms (“compression syndrome”). Ulceration and bleeding into the lumen of the cyst are often observed. When infected with microbial flora, cysts can fester. Cases of their malignant transformation have also been described, which is also observed with other benign neoplasms of the esophagus in 10% of patients.

Other types of benign tumors are extremely rare and are described in the literature as casuistic observations. In this case, one should remember about the possibility of profuse bleeding from cavernous hemangiomas of the esophagus, which pose significant difficulties in terms of diagnosis and treatment.

Diagnosis of Benign tumors of the esophagus:

Objective examination, as a rule, does not reveal specific symptoms of benign tumors of the esophagus. If they are large in size, dullness of percussion sound in the posterior parts of the lungs, as well as typical manifestations of “compression syndrome,” may be detected. The main methods of instrumental diagnosis are radiography of the esophagus, esophagoscopy and computed tomography.

On X-ray examination, intraluminal tumors appear as a local thickening of one of the folds (at an early stage of development) or a rounded filling defect on a broad base or on a pedicle. Its outlines are sharp, sometimes finely wavy. The structure of the papilloma shadow can be reticular due to the spectacled nature of its surface. The folds of the mucous membrane are thickened and go around the polyp. Peristalsis is not impaired; retention of the contrast mass occurs only when the neoplasm is large or when it is localized in the abdominal part of the esophagus above the cardial part of the stomach. When swallowing, the formation moves along with the wall of the esophagus in the proximal direction.

With intramural tumors, the folds of the mucous membrane are preserved, they can only go around the tumor and are usually narrowed or flattened. The tumor itself produces a marginal filling defect with smooth contours. Peristalsis and elasticity of the esophagus in the area of ​​tumor projection are preserved. If the tumor grows from the muscle membrane and has led to its atrophy, a break in peristalsis is observed. The tumor usually moves well when swallowing. With predominantly extraesophageal growth and its connection with the mediastinal organs, displacement is limited. The most common symptom is a marginal filling defect with clear, even contours. Unlike a filling defect due to external compression of the esophagus, benign tumors do not cause displacement of the esophagus from surrounding organs. Their distinctive feature is the presence of a clear angle between the wall of the unchanged esophagus and the edge of the tumor (the “visor” symptom), revealed in the lateral projection. On good x-rays and tomograms (especially computer scans), it is possible to obtain an image of that part of the tumor that protrudes into the surrounding mediastinal tissue. With large tumors, a spindle-shaped expansion of the overlying parts of the esophagus is observed.

With predominantly extraesophageal tumor growth, its relationship with the surrounding mediastinal organs can be studied using pneumomediastinography. In these cases, X-ray examination is performed after introducing gas (oxygen) into the mediastinum. Computed tomography provides more complete information. This research method makes it possible to differentiate esophageal cysts (which absorb x-rays less readily) from solid tumors.

All patients with suspected esophageal tumor are recommended to undergo esophagoscopy. With intraluminal tumors, round formations are revealed, covered with a slightly changed mucous membrane. During instrumental palpation, moderate bleeding of the mucous membrane is possible. A targeted biopsy followed by a morphological examination of the material makes it possible to establish a final diagnosis and verify the histological structure of the tumor.

For intramural tumors characterized by the presence of a formation protruding into the lumen of the esophagus." The mucous membrane above it, as a rule, is not changed, its relief is preserved or somewhat smoothed. If the tumor is ulcerated, a defect in the mucous membrane can be detected. It should be emphasized that in the presence of an intact mucous membrane above the neoplasm, a biopsy when performing esophagoscopy, it is not necessary to perform it. This is due to the fact that during surgical treatment of intramural tumors it is usually possible to remove the tumor without damaging the mucous membrane covering it. If the patient has previously undergone an esophagobiopsy, when the tumor is isolated, the mucous membrane is easily injured, which opens the lumen of the esophagus. significantly increases the risk of postoperative complications. Therefore, the clinical use of biopsy is indicated only for intraluminal tumors and ulcerated intramural formations, when the mucous membrane over the tumor is already destroyed.

Differential diagnosis. It must be carried out primarily with malignant tumors of the esophagus. Considering that the clinical manifestations of these groups of diseases are quite similar and most often manifest themselves in the form of dysphagia, great attention should be paid to the medical history. The patient's younger age and long-term course of the disease without signs of intoxication and cachexia indicate a benign lesion of the esophagus. Nevertheless, instrumental research methods, primarily endoscopic examination, are of greatest importance in the differential diagnosis of benign and malignant tumors of the esophagus. In rare cases, the final diagnosis is made based on intraoperative findings or morphological examination of a removed specimen (emergency or planned).

Treatment of Benign tumors of the esophagus:

Treatment of benign esophageal tumors only operational. The indication for surgery is the real possibility of malignant degeneration, the development of “compression syndrome,” bleeding and other complications.

Intraluminal tumors located on a stalk can be removed using an endoscope using electrical excision. For intramural tumors, thoracotomy and enucleation of the tumor are usually performed, followed by restoration of the integrity of the muscular lining of the esophagus. During isolation of the tumor from the surrounding tissues, it is necessary to strive not to damage the mucous membrane in order to avoid the development of purulent complications in the postoperative period as a result of insufficient sutures. For large tumors with significant destruction of the muscular lining of the esophagus, in rare cases it is necessary to perform resection of the affected area of ​​the organ, followed by plastic surgery of its small or large intestine or esophagogastroanastomosis (if the tumor is localized in the lower third of the esophagus).

The outcomes of surgical treatment of benign esophageal tumors are quite favorable. Mortality usually does not exceed 1-3%. Relapses of the disease are very rare; in almost all patients, the function of the esophagus is restored in full, and the ability to work is not affected.

Which doctors should you contact if you have Benign tumors of the esophagus:

• Gastroenterologist

• Surgeon

Is something bothering you? Do you want to know more detailed information about Benign tumors of the esophagus, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can make an appointment with a doctor– clinic Eurolab always at your service! The best doctors will examine you, study external signs and help you identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor at home. Clinic Eurolab open for you around the clock.

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Peptic esophagitis

A benign tumor of the esophagus is diagnosed more often in men aged 55–60 years. This is a fairly rare occurrence among all gastrointestinal tumors and is considered a congenital defect of unknown etiology.

The disease is quite widespread and ranks 6th among cancer tumors. The development of a neoplasm is possible in any part of the gastric tract, and treatment is justified only at the initial stage of the disease when primary suspicious symptoms appear: excessive weight loss and the inability to swallow even soft food.

The tumor requires surgical removal, regardless of stage. According to the types and form of growth they are distinguished:

• intraluminal cancer;
• adenoma;
• papilloma;
• lipoma;
• fibroma.

A tumor in the esophagus can be detected at an early stage only through endoscopy. And in most cases, it is benign in nature, but when it grows into the trachea, bronchi, any part of the sternum, or other distant organs, it can degenerate into malignant.

Classification of esophageal tumor

The classification of esophageal tumors is presented in 2 large groups: benign and malignant.

A benign tumor, by nature, growth and etiological structure, develops in the form of adenoma, papilloma, lipoma, angioma, myoma, chondroma, myxoma. The most common type of tumor is non-epithelial. According to the shape and growth inside the walls, the development of a luminal intramural form occurs.

Malignant tumors of the esophagus, taking into account histology, depend on the structure, location and morphology. The following types of cancer are distinguished: melanoma, nonkeratinized squamous cell, transitional cell or mucoepidermoid. Taking this into account, oncologists determine treatment tactics during further observation of the patient.

Depending on the characteristics of growth and the degree of involvement of the esophagus, the following types are distinguished:

• endogenous - when localized in the submucosal layer of the esophagus;
• exophytic - when formed in the lumen of the esophagus, just above the mucous layer;
• mixed - when formed in any layers of the walls of the esophagus with subsequent ulceration, disintegration, necrosis of the walls of the esophagus, the appearance of ulcerative areas in the affected areas.

In the initial stages, benign tumors of the esophagus are successfully treated. Oncologists give quite encouraging prognoses, survival for 5 years in 80–90% of cases. At stage 4 of cancer, when metastases have spread, the tumor is already difficult to treat even with the latest techniques in oncology.

Benign tumors of the esophagus are more of a congenital origin with growth in the form of an epithelial or non-epithelial cyst. In form - in the form of intraluminal adenoma, fibroma, lipoma, papilloma, leading to narrowing of the lumen in the larynx, asphyxia, suffocation and sudden death.

When the tumor is localized inside the walls in the lower part of the esophagus, symptoms may not manifest themselves for a long time. Only with excessive compression of the walls, which leads to blocking of the esophageal lumen, symptoms can manifest themselves in the form of:

• food obstruction;
• chest pain;
• nausea, gag reflex;
• decreased appetite;
• difficulty swallowing;
• shortness of breath;
• cough;
• hoarseness of voice;

In advanced cases, fibroids develop when the tumor reaches a gigantic size up to 18 cm in length, but is asymptomatic and only as it develops leads to decay, internal bleeding, and covering the mucous membrane with erosions.

When the formation is localized in the lower part of the esophagus, a cyst may develop as a benign formation, often congenital, with a cavity filled with yellowish serous-purulent fluid. The structure of the mucosa eventually acquires a hemorrhagic tint, and the tumor quickly increases in size. When the secretion of gastric juice is activated, the esophagus is compressed in part of the mediastinum, then more pronounced clinical symptoms begin to appear, and treatment becomes difficult. In the event of profuse bleeding, the tumor transforms into a malignant form, suppuration occurs with the addition of anaerobic microbial flora, and further spread of metastases occurs.

Primary signs of the disease

The primary initial stage of cancer practically does not manifest itself in any way. There are no symptoms even at stages 2–3 of the pathology. Often, a tumor is detected by chance, when dysphagia of the esophagus, difficulty swallowing even liquid food against the background of the development of an inflammatory process in the throat, is already obvious. Gastrointestinal problems begin, passage of food becomes difficult, pain behind the sternum, weakness and fatigue appear.

Such symptoms should be a reason to consult a doctor; this already indicates disorders in the body and the need for diagnostics.

Benign tumors of the esophagus are quite rare and occur in only 1% of cases. Most often, leiomyoma develops in the form of an epithelial glandular polyp, adenoma, hemangioma, chondroma, myxoma. A benign tumor can be detected in any part of the esophagus, most often as a single pedunculated polyp with a smooth or tuberous structure. Depending on the type and clinical characteristics, the polyp can grow in multiple forms, leading to:

• swallowing dysfunction;
• sore throat;
• problems with taking even liquid food;
• sense of presence;
• nausea and vomiting;
• increased salivation;
• mild pain in the sternum, aggravated by eating;
• weakness, dizziness, fatigue in case of internal bleeding;
• the appearance of ulcers;
• weight loss for no reason;
• signs of anemia due to iron deficiency in case of internal bleeding.

Often, a tumor is detected only during a random X-ray of the peritoneal organs.

What complications can it lead to?

If the disease is not treated promptly, a large tumor will ultimately lead to complete blockage and obstruction of the esophageal canal, the inability to swallow even the most liquid food, hemorrhage due to decay, bleeding and thinning of the walls of the esophagus.

The patient begins to refuse food; against the background of tumor disintegration, a paroxysmal cough appears, perforation of the trachea, fistulas in the esophagus with further spread into the blood vessels and parts of the mediastinum.

The condition worsens greatly when metastases spread to the area above the collarbone, liver, bone structures, lungs, brain, upper neck.

In order to diagnose and clarify the diagnosis, CT, MRI, ultrasound, esophagogastroduodenoscopy are required to view the mucous membrane of the esophagus, identifying the type, shape and size of the tumor. X-rays are taken with the introduction of a contrast agent to identify irregularities indicating the location of the tumor and the degree of patency in the esophagus.

Treatment of the disease

Treatment must be carried out when the most primary unpleasant symptoms and deterioration in swallowing functions appear. If you suspect benign tumors of the esophagus, you should not hesitate to contact a surgeon or gastroenterologist for advice. If the disease is not treated at the initial stage, complications, deterioration of well-being and death are inevitable.

If an intraluminal tumor on the pedicle is detected, electrical excision is prescribed; if an intrasystemic tumor is detected, thoracotomy is prescribed with the possibility of restoring the integrity of the muscular lining of the esophagus in the future.

The main treatment for esophageal cancer is surgery. The main thing is not to harm the mucous membrane, to avoid the development of a purulent process. If the tumor has reached a large size and led to partial destruction of the muscular lining of the esophagus, then it is possible to carry out measures for resection of the esophagus. Surgery and radiation therapy remain the best methods of treating the tumor today, achieving success in 40% of cases. Chemotherapy is prescribed only when low-cell or differentiated forms of cancer are detected.

Surgical treatment is carried out with the introduction of an endoscope to remove the tumor. After surgery, patients will have to undergo a long rehabilitation period to restore damaged tissues of the esophageal mucosa.

A special diet No. 1, 5, 16 and proton pump inhibitors are prescribed. Benign tumors are well treated with traditional herbs and proton pump beta blockers to reduce the production of hydrochloric acid in the stomach.

Unconventional treatment

Traditional methods of treatment do not guarantee a 100% cure for malignant neoplasms, so you should not rely on them alone. All folk remedies should be used only in addition to drug treatment.

Many traditional medicine recipes have been known to people for hundreds of years. The main methods of folk treatment for cancer are tinctures, herbs, infusions of herbs and mushrooms. Some herbs and fruits actually contain substances that stop and inhibit the growth of malignant tumors and, in particular, cancerous tumors of the esophagus.

To treat with folk remedies, you need to contact a herbalist who will advise you on how to properly prepare and take the decoction.

Prognosis for esophageal cancer

It is no longer possible to fully treat esophageal cancer. The sooner and sooner you seek help from doctors, the greater the chance of success and complete suppression of the tumor, minimizing the consequences and relapse in the future.

The insidiousness of esophageal cancer lies in the absence of symptoms. Patients often turn to specialists when the process is already too advanced, and even surgery does not guarantee complete eradication of the tumor. If the disease is not treated, death can occur suddenly within the first 6–7 months, although up to 7 years may pass from the onset of tumor development.

In advanced cases, when the tumor grows strongly and metastases to other neighboring organs, it becomes pointless to perform surgery. At stages 3–4 of cancer, doctors often decide to carry out radiation and chemotherapy, but already guarantee survival for 5 years for 15% of patients. Although modern techniques and developed treatment today can significantly increase these survival rates. A benign tumor has a completely favorable outcome if removed in a timely manner, and rarely leads to relapses and loss of ability to work in the functions of the esophagus.

Page 7 of 8

Cysts are detected approximately p. 8 times less common than tumors [Mlynchik V. E. et al., 1975]. There are acquired and congenital cysts.

Rice. 15. X-ray. Esophageal cyst and symptomatic achalasia.
a - rigidity of the lateral wall and atypia of the relief; b - tight filling, the contours of the esophagus have not changed, the patency of the cardia is impaired.

Thin walls and liquid contents of the cyst lead to variability in the X-ray picture during different phases of breathing or during Valsalva and Müller maneuvers. If at rest the cyst resembles a hanging drop, then when you take a deep breath it stretches into the shape of a pear, egg or rugby ball, and when you exhale it rounds again, resembling an apple. These symptoms allow us to speak quite confidently about a cyst. The image intensity of such cysts is usually lower compared to other pathological formations. If the wall is thick, cartilaginous, and the contents are thick and pasty, then the cyst is no different from a leiomyoma or esophageal polyp.
Treatment of cysts is only surgical.