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Endoscopic signs of esophageal tumors
Last reviewed: 06.07.2025
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Benign tumors of the esophagus
Benign tumors of the esophagus are divided into:
Exophytic tumors. They grow mainly into the lumen of the esophagus:
- polyp,
- papilloma,
- lipoma,
- leiomyoma, etc.
Endophytic tumors (intramural). They are difficult to diagnose, mainly by changes in the color and relief of the mucosa, local changes in the lumen and a small prestenotic expansion. The mucosa over the endophytic tumor may be eroded, edematous, or may be unchanged. Positive tent symptom. With instrumental palpation of a dense-elastic consistency.
Leiomyoma. Makes up to 70%. This is a submucous non-epithelial tumor consisting of randomly located bundles of smooth muscles of the esophagus. In 50% it is located in the lower third of the esophagus.
There are 3 forms of tumor:
- in the form of an isolated node,
- in the form of multiple nodes,
- disseminated leiomyomatosis of the esophagus.
Leiomyoma looks like a regular round or oval-shaped formation protruding into the lumen of the esophagus, quite dense, not fused with the mucosa (with large sizes and ulceration it can be fused - then the tent symptom is negative). Like all submucous tumors of the esophagus, the size and shape of leiomyoma do not change with breathing. The course is asymptomatic for a long time, manifested by bleeding or dysphagia.
Tactics: up to 2 cm is usually removed through an endoscope, but if there is a history of bleeding, surgery is better. For larger sizes, observe dynamically once every 6 months. In case of rapid growth and bleeding, surgery.
Papilloma. Externally, it is a whitish elevation against a pink mucous membrane, growing on a stalk or on a wide base. The size is from a pinhead to 0.2-0.5 cm. Papillomas can be single or multiple. They have a high malignancy index. They are subject to endoscopic removal with histological examination.
Polyps. Rare. Located everywhere. Round or ovoid shape, smooth surface, even contours, no difference in color from surrounding tissues, but may be slightly brighter. Located on a stalk or broad base. Often ulcerate. Sizes are usually 0.3-1.5 cm. Tactics: endoscopic polypectomy for polyps up to 2 cm on a broad base and up to 4 cm on a stalk.
Lipoma. Large lobular tumors, fused with mucous, yellowish in color.
Esophageal cancer
This is a widespread disease - from 10 to 90% of all esophageal diseases according to various sources.
Localization:
- in the upper third - 15-20%,
- in the middle third - 37-47%,
- in the lower third - 38-43%.
Histological structure:
- 90% - squamous cell carcinoma,
- 10% - adenocarcinoma of the glands themselves, mucous and cardiac glands.
There is no generally accepted macroscopic classification of esophageal cancer. The most common forms are:
- Exophytic (nodular).
- Endophytic (diffuse-infiltrative, sclerosing).
- Mixed (ulcerative).
In exophytic cancer, the tumor grows into the lumen of the esophagus, resembling a mulberry or cauliflower in appearance. It reaches various sizes. It disintegrates early and bleeds.
In endophytic cancer, the tumor spreads along the submucosal layer along the entire circumference of the esophagus, causing its narrowing up to complete obstruction. Due to the slow growth of the tumor, suprastenotic expansion often forms.
Ulcerative cancer combines the features of delimited and infiltrative growth. It ulcerates quickly. The ulcer has dense, raised, ridge-shaped, bumpy edges and bleeds easily.
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