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Cervical Esophageal Cancer

Understanding the Anatomy

The throat is made up of a many different parts. The esophagus is a muscular tube that carries food and liquids from the throat into the stomach. It is located behind the breathing tube (trachea, or windpipe).

4a throat overview

The esophagus is divided into three parts, going from the top to the bottom: the cervical esophagus, thoracic esophagus and abdominal esophagus. Because the cervical esophagus is in the neck, many people still consider this in the general category of throat cancer. Sometimes taking a measurement of the distance from the teeth is useful to determine where the cancer is located. The location of the cancer is defined by the top of the tumor.

30_1_esophagus_regions

  • Cervical esophagus: This part of the esophagus extends from the hypopharynx to the sternal notch (the indentation in the middle of your neck between the two collarbones). It goes from 16 centimeters from the teeth to where the esophagus enters the chest (approximately 20 centimeters from the teeth).
  • Thoracic esophagus: This part of the esophagus extends from the sternal notch down to where the stomach and esophagus join. It stretches approximately 20 to 40 centimeters from the teeth. It is divided into upper, middle and lower thoracic esophagus.
  • Abdominal esophagus: This part of the esophagus extends from the esophagus/stomach junction and five centimeters below. Cancers in the uppermost part of the stomach are fairly similar to esophageal cancer (in type and the way they behave), so they are often grouped here. Whether to call a tumor here a stomach cancer or an esophagus cancer is open to debate.

In front of the cervical esophagus is the trachea (windpipe). Behind the cervical esophagus is the tissue covering the spine. Beside the cervical esophagus are the structures in the carotid sheath. Also, the thyroid gland curves around from the front of the neck and can sit beside the cervical esophagus as well.

The layers of the esophagus are important to know. How deeply the cancer invades is important to determining the stage of the cancer.
30_esophagus_layers

  • Mucosa: This is the inner lining of the esophagus. The mucosa has three layers:
    • Epithelium: The mucosa of the esophagus is lined with squamous epithelium, and cells that turn cancerous in this layer lead to squamous cell carcinima. In the lower part of the esophagus, the squamous cells can be replaced with gland-like cells and lead to adenocarcinoma.
    • Lamina propria: This is a thin line of tissue just below the epithelium. If the cells invade past this, then we can call it cancer (T1 or greater).
    • Muscularis mucosa: This is a really thin layer of involuntary muscle.
  • Submucosa: This layer has mainly mucous glands that keep the esophagus lubricated and help food pass down the tube easily. There is also some tissue called loose connective tissue in this layer, as well as blood vessels and nerves.
  • Muscularis propria (also called the external muscle layer): This is a thicker layer of muscle than the thin muscularis mucosa. This muscle layer is responsible for the coordinated movement of food from the cervical esophagus all the way down to the stomach.
  • Adventitia: This is the outermost layer of the esophagus. Once cancer cells invade into the adventitia, it’s a T3 cancer. If the cells go through this layer, they can get into some of the structures outside of the esophagus.

Another important consideration in esophageal cancer anatomy is the issue of regional lymph nodes. While lymph nodes for other head and neck cancers are located in the face or the neck, esophageal regional lymph nodes are in the lower neck and in the chest.

  • Supraclavicular zone: These are nodes in the central part and the sides of the neck just above the collar bones. This includes lymph nodes in the sternal notch.
  • Superior mediastinal / aortic / inferior mediastinal / pulmonary nodes: These are lymph nodes in the chest and are best evaluated by thoracic and gastrointestinal specialistis with imaging and endoscopic ultrasound.

 

References

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