1.3. Oesophageal Disease - Oesophageal Cancer Flashcards
What are the 2 Types of Oesophageal Cancer?
- Squamous Cell Carcinoma
2. Adenocarcinoma
Which part of the Oesophagus is Squamous Cell Carcinoma found?
The Proximal 2/3
Which part of the Oesophagus is Adenocarcinoma found?
The Distal 1/3
Is Oesophageal more common in Males or Females?
Males
What is the Median Age of presenting with Oesophageal Cancer?
65 - and decreasing
What precedes Oesophageal Squamous Cell Carcinoma?
- Dysplasia
2. Carcinoma in Situ
What precedes Oesophageal Adenocarcinoma?
Barrett’s Oesophagus
What are the predisposing factors of Squamous Cell Carcinoma?
- Excessive consumption of Alcohol
- Smoking
- Vitamin Deficiencies
- Achalasia
- Caustic Strictures
- Plummer-Vinson Syndrome
What are the predisposing factors of Adenocarcinoma?
The Risk Factors for GORD / Berrett’s Oesophagus:
- Being Male
- Caucasian
- Middle Aged
- Obese
What is the Pathology of Oesophageal Squamous Cell Carcinoma?
This is the Standard Cancer Pathology - A mutation, with the correct genetic susceptibility, leading to Dysplasia
What is the Pathology of Oesophageal Adenocarcinoma?
The Metaplasia in Barrett’s Oesophagus, continues to Dysplasia - leading to Cancer
What are the Clinical Signs of Oesophageal Cancer?
- Weight Loss
- Aspiration Pneumonia
- Vocal Cord Paralysis
- Haematemesis
Why does Weight Loss occur?
- Due to the presence of the Cancer
2. Due to the trouble eating, associated with the location of the Cancer
Why does Aspiration Pneumonia potentially occur?
Due to the potential presence of a Tracheo-Oesophageal Fistula
Why does Vocal Cord Paralysis potentially occur?
Due to the Potential Invasion / Compression of the Vocal Cords
What is Haematemesis?
Blood in Vomit
Why does Haematemesis occur?
Due to the Bleeding associated with the Cancer
What would a patient with Oesophageal Cancer present with?
- Dysphagia
- Odynophagia
- Chest Pain
- Vomiting
What is Dysphagia?
The Feeling of having trouble swallowing
What is Odynophagia?
The feeling of Pain on Swallowing
What causes the Symptoms in Oesophageal Cancer?
The presence of the Abdominal Mas infiltrating and compressing the surrounding Lumen / Structure
What investigations are needed in Oesophageal Cancer?
- Upper G.I. Endoscopy with Biopsy
- CT/PET Scan
- Endoscopic Ultrasound
What is the purpose of the Upper G.I. Endoscopy with Biopsy?
- To view and assess the severity of the tumour
2. The Grade the cancer
What is the purpose of the CT/PET scan?
This is used for Staging Purposes - looking for Metastases
Where needs to be scanned in the CT/PET scan?
- Chest
- Abdomen
- Pelvis
What is the purpose of the Endoscopic Ultrasound?
To assess the surrounding structures - for Staging Purposes
What staging Criteria is used?
TNM
What are the Different “T” stages in Oesophageal Cancer?
- T1a
- T1b
- T2
- T3
- T4
What does “T1a” refer to?
A Tumour which has invaded the Lamina Propria
What does “T1b” refer to?
A Tumour which has invaded the Sub-Mucosa
What does “T2” refer to?
A Tumour which has invaded the Muscularis Externa
What does “T3” refer to?
A Tumour which has invaded the Oesophageal Adventitia
What does “T4” refer to?
A Tumour which has invaded the Adjacent (Surrounding) Structures
What are the Different “N” stages in Oesophageal Cancer?
- N0
2. N1
What does “N0” refer to?
No Regional Lymph Node Metastases
What does “N1” refer to?
Regional Lymph Node Metastases
What are the Different “M” stages in Oesophageal Cancer?
- M0
2. M1
What does “M0” refer to?
No Metastases
What does “M1” refer to?
Metastases
What is the only Cure of Oesophageal Carcinoma?
An Oesophagectomy
What is an Oesophagectomy?
The Surgical Removal of the Oesophagus, and the Stomach is stretched to reach the Upper Oesophageal Sphincter
What is used alongside the Oesophagectomy?
Chemotherapy
What are the 2 times Chemotherapy can be used?
- Adjuvant
2. Neoadjuvant
What is Adjuvant Chemotherapy?
Chemotherapy after the Operation, to remove anything which might be left
What is Neoadjuvant Chemotherapy?
Chemotherapy before the Operation, to reduce the size of the tumour
What are some palliative care options?
- Endoscopic Stenting
- Endoscopic Argon Plasma Coagulation
- Percutaneous Endoscopic Gastrostomy (PEG)
- Chemotherapy
- Radiotherapy
What is the function of the Endoscopic Stenting?
To reduce the Symptom of Dysphagia
What is the function of Endoscopic Argon Plasma Coagulation?
To reduce the Symptom of Bleeding (Haematemesis)
What is the function of a Percutaneous Endoscopic Gastrostomy?
To allow feeding to take place if the Tumour is too large that it obstruct the whole passage to the Stomach
What is the function of Palliative Chemotherapy / Radiotherapy?
This is just done to reduce the Symptoms
How common are Benign Oesophageal Tumours?
Very Rare
In Western Europe / USA. which type of Oesophageal Carcinoma is most common?
Adenocarcinoma
In the rest of the World, other than Western Europe / USA,. which type of Oesophageal Carcinoma is most common?
Squamous Cell Carcinoma
