All of the following predisposes to carcinoma of the esophagus except: September 2008
Ans. B: Zenker's diveiculum In Achalasia, with time the esophagus dilates and contractions disappear, so that the 'megaoesophagus' becomes touous with a persistent retention esopahitis due to the fermentation of food residues, and this may account for increased incidence of carcinoma of the esophagus Plummer-Vinson disease/Paterson-Kelly syndrome/Sideropenic dysphagia includes a post-cricoidal web , iron deficiency anemia, glossitis and koilonychia. Some patient may have oropharyngeal leucoplakia, and this may account for an alleged risk of developing hypopharyngeal cancer. Barrett esophagus is a premalignant condition that involves the distal esophagus and appears to be related to chronic gastroesophageal reflux (CORD). There is metaplastic change in the lining mucosa of esophagus. Usually there are no paicular severe symptoms, although they do have the most abnormal pH profiles. Patients with Barrett esophagus are predisposed to the most rapidly increasing cause of cancer. The diagnosis of Barrett esophagus is made at endoscopy when the normal, whitish-appearing squamous epithelium is found to be replaced by a reddish, velvety-appearing intestinal type of columnar epithelium. Barrett esophagus is thought to evolve to cancer through various stages of dysplasia. Initially, no dysplasia is found; subsequently, low-grade dysplasia develops in the mucosa, then high-grade dysplasia, and finally carcinoma. Dysplasia is considered indefinite when histological changes are not definitive for dysplasia. Most of these changes cannot be visualized endoscopically. The hallmark of specialized Barrett's epithelium is the presence of mucus-secreting goblet cells (intestinal metaplasia). Patients are usually monitored by a program of periodic surveillance endoscopy during which biopsy specimens are taken in 4 quadrants every 2 cm throughout the Barrett segment. Treatment is that of the underlying cause of CORD Zenker's diveiculum is not really an esophageal diveiculum as it protrudes posteriorly above the cricopharyngeal sphincter through the natural weak point (the dehiscence of Killian).As the pouch enlarges , it tends to filled with food on eating, and the fundus descends into mediastinum.This leads to halitosis and esophageal dysphagia.
Achalasia
Zenker's diveiculum
Barrett's esophagus
Plummer-Vinson disease