OESOPHAGEAL CARCINOMA : SPREAD , INVESTIGATION

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.