larynx take it down the esophagus nam two miles is up there this is the sound is coming down the summit here and you can see we we've opened an office is rough in the area and the cut surface area to see at the wall a second this is a very advanced carcinoma aligning of the esophagus disclaimers in this was a square must sell carcinoma desert you can imagine will produce a mechanical problems patients will have trouble swallowing and there again i've seen patients come in and strain baby food before they finally say oncall and decide that something might be wrong and these are very hard to cure because of the fact that they are advancing their local my pastor sees it's not just in the past the seas we can also see adamo carcinomas nearsightedness because there are some glandular epithelium there that can also give rise now if you look at that i tell you this is a stomach has been opened in washington is the esophagus up there is this do indian coming off over here if you look at that for a while at first you might say well nothing wrong on that but you'll notice that the normal full pattern desire note here it doesn't look so awful that at first blush but that is a diffuse lee infiltrated carcinoma what kind is suppose it is given up his stomach is a glandular lying adenocarcinoma and uh... these things are very subtle and a symptomatic until their advance this was very advances as medicine at ican liver already at the time it came uh... so they may have traditionally symptoms at all and interesting wrinkle here is uh... the incidence of this kind of tumor is very high in japan much higher than here and it's largely in environmental thing because the descendants of japanese who come here or pick up our other yankee problems but uh... this incident changes but it's such a public health problem that they will screen for this sort of thing because there's nothing like this could produce symptoms early on so the only hope of getting it earlier is played by population screening and that's that's another matter for another time here's one that will anticipate uh... this afternoon getting down to a large intestine this is actually in the first part of a large intestine over here right where the small intestine answers for the appendix comes offices so called safe this about poultry four inches in diameter and there's a huge fung gaining neoplasm there anissa grown glandular lining so it's an adamo carcinoma now in terms of our clinical present asian uh... this thing isn't going to his big is that there is a good person that's trucked something bad big so that the first confiscate passing by doesn't cause any pain at least at this stage one things that happens with these as they believe you know the passing traffic will will erode the surface and they'll believe they'll lose blood this is all borrow three feet from the ins_ colin goes up here cross here down here there's a little blue goes out in the fact is five times the blood goes from there to meet a nice it's no longer rat its black the patient will be passing schools that i mean if he's losing enough blood we passing stools that perhaps look tari that's the efforts that given to them something we called mellon up learn ad-aware you don't know if mel_ dna_ means blackberry stole and patience will comment and a couple of ways with this they may say if their particular instrument look in the bolded for a flash uh... dr harry schools was wrong more unlikely in this is something you must always remember middle-aged or elderly patient comes an incentive i'm just proved all the time you know describes being he's easily fatigued and weak and so forth you take a look and they were kind of payal are you doing a glowing you find it terribly anemic it's from chronic i called blood loss like this climate chances on the right side in the korea's jess's all through the colon uh... this is one very closely nis wishes in circles the whole by all around 