[37] Oesophageal Cancer Flashcards
What is the incidence of oesophageal cancer?
12/100,000
Why is the incidence of oesophageal cancer increasing?
Due to increase in Barrett’s oesophagus
What age does oesophageal cnacer occur?
50-70
What is the male to female ratio of oesophageal cancer?
M:F = 5:1
What countries have a higher incidence of oesophageal cancer?
Iran
Transkei
China
What are the risk factors for oesophageal cancer?
Alcohol Smoking Achalasia GORD leading to Barrett's oesophagus Plummer-Vinson synrome Fatty diet Reduced vitamin A and C Nitrosamine exposure
What are the types of oesophageal cancer?
Adenocarcinoma
Squamous cell carcinoma
What % of oesophageal cancers are adenocarcinomas?
65%
What % of oesophageal cancers are squamous cell carcinomas?
35%
Where do adenocarcinomas of the oesophagus occur?
Lower 1/3
What causes adenocarcinoma of the oesophagus?
GORD → Barrett’s → dysplasia → cancer
Where do oesophageal SCC occur?
Upper and middle 3rd
What are oesophageal SCC associated with?
Alcohol
Smoking
What is the most common type of oesophageal cancer worldwide?
SCC
How does oesophageal cancer present?
Progressive dysphagia
Weight loss
Retrosternal chest pain
Lymphadenopathy
What happens in progressive dysphagia?
Progresses from solids to liquids, often causing an alteration in dietary habits to soft food
What is the result of the change in diet as a result of the dysphagia in oesophageal cancer?
Exacerbation of weight loss
What symptoms of oesophageal cancer might occur if its in the upper 1/3?
Hoarseness
Cough, with or without aspiration pneumonia
Why might oesophageal cancer cause hoarseness?
Recurrent laryngeal nerve invasion
How does oesophageal cancer spread?
Direct extension, lymphatics, and blood
What % of patients with oesophageal cancer have mets at diagnosis?
75%
How is oesophageal cancer investigated?
Bloods
Upper GI endoscopy and biopsy
Barium swallow (not often used)
Staging investigations
What might be found on bloods in oesophageal cancer?
Anaemia
Deranged LFTs/albumin
What might cause deranged LFTs/albumin in oesophageal cancer?
Liver mets
What is found on barium swallow in oesophageal cancer?
Apple-core stricture
What staging investigations are done in oesophageal cancer?
CT
EUS
Laparoscopy/mediastinotomy to look for mets
What is Tis in oesophageal cancer?
Carcinoma in situ
What is T1 in oesophageal cancer?
Confined to submucosa
What is T2 in oesophageal cancer?
Invades muscularis propria (circular or longitudinal)
What is T3 in oesophageal cancer?
Invades adventitia
What is T4 in oesophageal cancer?
Invades adjacent structures
What is N1 in oesophageal cancer?
Regional nodes
What is M1 in oesophagael cancer?
Distant mets
Who needs to be in the MDT for discussion of oesophageal cancer?
Upper GI surgeon Gastroenterologist Radiologist Pathologist Oncologist Specialist nurses Macmillan nurses Palliative care
What is the surgical option in oesophageal cancer?
Oesophagectomy
What % of people with oesophageal cancer have resectable tumours?
25-30%
What is the purpose of neo-adjuvant chemotherapy in oesophageal cancer?
Down-stage the tumour
What neo-adjuvant chemotherapy might be given in oesophageal cancer?
Cisplatin + 5FU
What are the approaches to oesophagectomy in oesophageal cancer?
Ivor-Lewis
McKeown
Trans-hiatal
What is the prognosis of oesophageal cancer dependant on?
The stage
What is the overall prognosis of oesophageal cancer in those who have surgery?
15% at 5 years
What are the options for palliative care in oesophageal cancer?
Laser coagulation Alcohol injections Stenting Drainage of ascites Secretion reduction Analgesia Radiotherapy
What can be used for secretion reduction in oesophageal cancer?
Hyoscine patch
What can be used for analgesia in oesophageal cancer?
Fentanyl patches
What radiotherapy might be used for palliative care in oesophageal cancer?
External or brachytherapy
What is the prognosis of non-resectable oesophageal cancer?
5% at 5 years, with median survival 4 months
Give 4 benign tumours of the oesophagus
Leiomyoma
Lipoma
Haemangioma
Benign polyps
