[37] Oesophageal Cancer

Question 1

What is the incidence of oesophageal cancer?

Answer 1

12/100,000

Question 2

Why is the incidence of oesophageal cancer increasing?

Answer 2

Due to increase in Barrett’s oesophagus

Question 3

What age does oesophageal cnacer occur?

Answer 3

50-70

Question 4

What is the male to female ratio of oesophageal cancer?

Answer 4

M:F = 5:1

Question 5

What countries have a higher incidence of oesophageal cancer?

Answer 5

Iran
Transkei
China

Question 6

What are the risk factors for oesophageal cancer?

Answer 6

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

Question 7

What are the types of oesophageal cancer?

Answer 7

Adenocarcinoma

Squamous cell carcinoma

Question 8

What % of oesophageal cancers are adenocarcinomas?

Answer 8

65%

Question 9

What % of oesophageal cancers are squamous cell carcinomas?

Answer 9

35%

Question 10

Where do adenocarcinomas of the oesophagus occur?

Answer 10

Lower 1/3

Question 11

What causes adenocarcinoma of the oesophagus?

Answer 11

GORD → Barrett’s → dysplasia → cancer

Question 12

Where do oesophageal SCC occur?

Answer 12

Upper and middle 3rd

Question 13

What are oesophageal SCC associated with?

Answer 13

Alcohol

Smoking

Question 14

What is the most common type of oesophageal cancer worldwide?

Answer 14

SCC

Question 15

How does oesophageal cancer present?

Answer 15

Progressive dysphagia
Weight loss
Retrosternal chest pain
Lymphadenopathy

Question 16

What happens in progressive dysphagia?

Answer 16

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

Question 17

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

Answer 17

Exacerbation of weight loss

Question 18

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

Answer 18

Hoarseness

Cough, with or without aspiration pneumonia

Question 19

Why might oesophageal cancer cause hoarseness?

Answer 19

Recurrent laryngeal nerve invasion

Question 20

How does oesophageal cancer spread?

Answer 20

Direct extension, lymphatics, and blood

Question 21

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

Answer 21

75%

Question 22

How is oesophageal cancer investigated?

Answer 22

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

Question 23

What might be found on bloods in oesophageal cancer?

Answer 23

Anaemia

Deranged LFTs/albumin

Question 24

What might cause deranged LFTs/albumin in oesophageal cancer?

Answer 24

Liver mets

Question 25

What is found on barium swallow in oesophageal cancer?

Answer 25

Apple-core stricture

Question 26

What staging investigations are done in oesophageal cancer?

Answer 26

CT EUS Laparoscopy/mediastinotomy to look for mets

Question 27

What is Tis in oesophageal cancer?

Answer 27

Carcinoma in situ

Question 28

What is T1 in oesophageal cancer?

Answer 28

Confined to submucosa

Question 29

What is T2 in oesophageal cancer?

Answer 29

Invades muscularis propria (circular or longitudinal)

Question 30

What is T3 in oesophageal cancer?

Answer 30

Invades adventitia

Question 31

What is T4 in oesophageal cancer?

Answer 31

Invades adjacent structures

Question 32

What is N1 in oesophageal cancer?

Answer 32

Regional nodes

Question 33

What is M1 in oesophagael cancer?

Answer 33

Distant mets

Question 34

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

Answer 34

``` Upper GI surgeon Gastroenterologist Radiologist Pathologist Oncologist Specialist nurses Macmillan nurses Palliative care ```

Question 35

What is the surgical option in oesophageal cancer?

Answer 35

Oesophagectomy

Question 36

What % of people with oesophageal cancer have resectable tumours?

Answer 36

25-30%

Question 37

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

Answer 37

Down-stage the tumour

Question 38

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

Answer 38

Cisplatin + 5FU

Question 39

What are the approaches to oesophagectomy in oesophageal cancer?

Answer 39

Ivor-Lewis McKeown Trans-hiatal

Question 40

What is the prognosis of oesophageal cancer dependant on?

Answer 40

The stage

Question 41

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

Answer 41

15% at 5 years

Question 42

What are the options for palliative care in oesophageal cancer?

Answer 42

``` Laser coagulation Alcohol injections Stenting Drainage of ascites Secretion reduction Analgesia Radiotherapy ```

Question 43

What can be used for secretion reduction in oesophageal cancer?

Answer 43

Hyoscine patch

Question 44

What can be used for analgesia in oesophageal cancer?

Answer 44

Fentanyl patches

Question 45

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

Answer 45

External or brachytherapy

Question 46

What is the prognosis of non-resectable oesophageal cancer?

Answer 46

5% at 5 years, with median survival 4 months

Question 47

Give 4 benign tumours of the oesophagus

Answer 47

Leiomyoma Lipoma Haemangioma Benign polyps