Spread :
1. Local spread or direct spread(a) To start with ,it is a mucosal ulceration which spreads to the submucosa . Later it causes fibrosis & the lumen gets narrowed .
(b) When the trachea is involved , tracheo-oesophageal fistula develops from carcinoma upper 1/3 of oesophagus .
(c) Broncho-oesophageal fistula from carcinoma middle 1/3 .
(d) Oesophagoaortic fistla results in massive bleeding .
(e) All these complications are contraindications for surgery & radiotherapy.
2. Lymphatic spread
3.Blood spread : It results in secondaries in liver , which clinically appear as nodular enlarged liver . Later ascites & retrovesical deposits occur .
Investigations :
1. Hb% is low ,which is the cause of generalised weakness .2. Liver function test is affected ,if secondaries in liver occur .
3. Ultrasound is done to rule out liver secondaries ,lymph nodes in the porta hepatis ,coeliac nodes etc.
4.Barium swallow demonstrates irregular , persistent ,intrinsic filling defect .
5. Oesophagoscopy to visualise the growth & to take biopsy.
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