Oesophageal Neoplasia

• Very rare accounting for less than 0.5% of all cancer, except where Spirocerca lupi is endemic (Africa and South-eastern USA).
• Most frequently reported types of neoplasm:
  • Squamous cell carcinoma - usually appears as an annualar thickening in the middle third of the oesophagus, anterior to the heart.
  • Leiomyosarcoma
  • Fibrosarcoma
  • Osteosarcoma
  • (Plasmacytoma)
  • (Local invasion of paraoesophageal tumours e.g. thryoid)
  • (Leiomyoma - benign, most frequently in the caudal oesophagus and cardia)

Signalment

• Most are older in age
• No sex predilection
• No breed predilection

Description

In Africa and South-eastern USA the parasitic worm Spirocerca lupi can cause oesophageal fibrosarcomas and osteoasarcomas. This is most likely due to the parasite secreting a carcinogen. The aetiology of carcinomas in other areas is idiopathic though potentially ingestion of carcinogens may be involved.

Diagnosis

History and Clinical Signs

Indicative of partial or complete upper gastrointestinal obstruction

• Signalment as above
• Non-specific signs of general poor condition and weight loss
• Dysphagia/Pain on swallowing
• Regurgitation
• Aspiration pneumonia (secondary to regurgitation)
• Hypertrophic osteopathy as a paraneoplastic syndrome - particulary those with sarcomas with Spirocerca lupi aetiology

Plain Radiography

A mass, intra-luminal gas retention or oesophageal stricture with a cranial dilation are not always visible. Contrast studies is requried to

Prognosis

Often poor as are usually advanced on time of diagnosis therefore resection options are poor. In addition, metastatic rate is high: malignant tumours are locally invasive and metastasis occurs via draining lymph nodes, haematogenous spread to distant areas.