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3: Surgery Y3 - Cancer Care [1] (check ILOs) > [37] Oesophageal Cancer > Flashcards

[37] Oesophageal Cancer Flashcards

1
Q

What is the incidence of oesophageal cancer?

A

12/100,000

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2
Q

Why is the incidence of oesophageal cancer increasing?

A

Due to increase in Barrett’s oesophagus

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3
Q

What age does oesophageal cnacer occur?

A

50-70

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4
Q

What is the male to female ratio of oesophageal cancer?

A

M:F = 5:1

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5
Q

What countries have a higher incidence of oesophageal cancer?

A

Iran
Transkei
China

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6
Q

What are the risk factors for oesophageal cancer?

A 
Alcohol
Smoking
Achalasia
GORD leading to Barrett's oesophagus
Plummer-Vinson synrome
Fatty diet
Reduced vitamin A and C
Nitrosamine exposure
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7
Q

What are the types of oesophageal cancer?

A

Adenocarcinoma

Squamous cell carcinoma

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8
Q

What % of oesophageal cancers are adenocarcinomas?

A

65%

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9
Q

What % of oesophageal cancers are squamous cell carcinomas?

A

35%

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10
Q

Where do adenocarcinomas of the oesophagus occur?

A

Lower 1/3

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11
Q

What causes adenocarcinoma of the oesophagus?

A

GORD → Barrett’s → dysplasia → cancer

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12
Q

Where do oesophageal SCC occur?

A

Upper and middle 3rd

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13
Q

What are oesophageal SCC associated with?

A

Alcohol

Smoking

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14
Q

What is the most common type of oesophageal cancer worldwide?

A

SCC

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15
Q

How does oesophageal cancer present?

A

Progressive dysphagia
Weight loss
Retrosternal chest pain
Lymphadenopathy

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16
Q

What happens in progressive dysphagia?

A

Progresses from solids to liquids, often causing an alteration in dietary habits to soft food

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17
Q

What is the result of the change in diet as a result of the dysphagia in oesophageal cancer?

A

Exacerbation of weight loss

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18
Q

What symptoms of oesophageal cancer might occur if its in the upper 1/3?

A

Hoarseness

Cough, with or without aspiration pneumonia

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19
Q

Why might oesophageal cancer cause hoarseness?

A

Recurrent laryngeal nerve invasion

20
Q

How does oesophageal cancer spread?

A

Direct extension, lymphatics, and blood

21
Q

What % of patients with oesophageal cancer have mets at diagnosis?

A

75%

22
Q

How is oesophageal cancer investigated?

A

Bloods
Upper GI endoscopy and biopsy
Barium swallow (not often used)
Staging investigations

23
Q

What might be found on bloods in oesophageal cancer?

A

Anaemia

Deranged LFTs/albumin

24
Q

What might cause deranged LFTs/albumin in oesophageal cancer?

A

Liver mets

25
Q

What is found on barium swallow in oesophageal cancer?

A

Apple-core stricture

26
Q

What staging investigations are done in oesophageal cancer?

A

CT
EUS
Laparoscopy/mediastinotomy to look for mets

27
Q

What is Tis in oesophageal cancer?

A

Carcinoma in situ

28
Q

What is T1 in oesophageal cancer?

A

Confined to submucosa

29
Q

What is T2 in oesophageal cancer?

A

Invades muscularis propria (circular or longitudinal)

30
Q

What is T3 in oesophageal cancer?

A

Invades adventitia

31
Q

What is T4 in oesophageal cancer?

A

Invades adjacent structures

32
Q

What is N1 in oesophageal cancer?

A

Regional nodes

33
Q

What is M1 in oesophagael cancer?

A

Distant mets

34
Q

Who needs to be in the MDT for discussion of oesophageal cancer?

A 
Upper GI surgeon
Gastroenterologist 
Radiologist
Pathologist
Oncologist
Specialist nurses
Macmillan nurses
Palliative care
35
Q

What is the surgical option in oesophageal cancer?

A

Oesophagectomy

36
Q

What % of people with oesophageal cancer have resectable tumours?

A

25-30%

37
Q

What is the purpose of neo-adjuvant chemotherapy in oesophageal cancer?

A

Down-stage the tumour

38
Q

What neo-adjuvant chemotherapy might be given in oesophageal cancer?

A

Cisplatin + 5FU

39
Q

What are the approaches to oesophagectomy in oesophageal cancer?

A

Ivor-Lewis
McKeown
Trans-hiatal

40
Q

What is the prognosis of oesophageal cancer dependant on?

A

The stage

41
Q

What is the overall prognosis of oesophageal cancer in those who have surgery?

A

15% at 5 years

42
Q

What are the options for palliative care in oesophageal cancer?

A 
Laser coagulation 
Alcohol injections 
Stenting 
Drainage of ascites
Secretion reduction
Analgesia
Radiotherapy
43
Q

What can be used for secretion reduction in oesophageal cancer?

A

Hyoscine patch

44
Q

What can be used for analgesia in oesophageal cancer?

A

Fentanyl patches

45
Q

What radiotherapy might be used for palliative care in oesophageal cancer?

A

External or brachytherapy

46
Q

What is the prognosis of non-resectable oesophageal cancer?

A

5% at 5 years, with median survival 4 months

47
Q

Give 4 benign tumours of the oesophagus

A

Leiomyoma
Lipoma
Haemangioma
Benign polyps

3: Surgery Y3 - Cancer Care [1] (check ILOs) (47 decks)

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