Background Flashcards

1
Q

What are the boundaries of the esophagus that divide it into Cx, upper T, midthoracic, lower T, and abdominal regions?

A

The esophagus spans from the cricopharyngeus at the cricoid to the esophageal-gastric junction (EGJ). The Cx esophagus spans from hypopharynx to sternal notch (15 to <20 cm from incisors), the upper T from the sternal notch to the azygos vein (20 to <25 cm), the middle T from azygos vein to inf pulmonary vein (25 to <30 cm), the lower T from the inf pulmonary vein to the EGJ (30 to <40 cm), and the abdominal from EGJ to 2 cm below EGJ (40 to 45 cm).

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2
Q

Why is esophageal cancer more prone to locoregional spread than other GI cancers?

A

The esophagus has an adventitial layer but does not have a serosal layer, thus reducing the resistance against local spread of cancer.

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3
Q

What is the incidence and mortality of esophageal cancer in the United States?

A

There are ∼17,000 cases diagnosed and ∼16,000 deaths per yr in the United States. Males are more commonly affected than females (3:1).

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4
Q

Is there an association b/t esophageal cancer and HPV infection?

A

The single largest case-control studies by Cao B et al. showed a risk of HPV 2.7-fold greater in cases of esophageal SCC than in controls. (Carcinogenesis 2005)

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5
Q

What are the risk factors for developing esophageal cancer?

A

Esophageal SCC risk factors: smoking/alcohol, tylosis, Plummer–Vinson syndrome, Fanconi anemia, Bloom syndrome, caustic injury to the esophagus, Hx of H&N cancer, and achalasia. HPV infection has been associated in ∼20% cases in high-incidence areas (China, Africa, and Japan) but none in low-incidence areas (Europe, United States).

Esophageal adenocarcinoma (adeno) risk factors: obesity/GERD, Barrett esophagus, lack of fruits/vegetables, low-socioeconomic status

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6
Q

What are some protective factors for developing esophageal cancers?

A

Protective factors for developing esophageal cancer include fruits/vegetables and Helicobacter pylori infection (possible atrophic gastritis).

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7
Q

How do pts with esophageal cancer typically present?

A

Dysphagia and weight loss (>90%), odynophagia, pain, cough, dyspnea, and hoarseness

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8
Q

What is the pattern of spread of tumors of the esophagus?

A

Tumors of the esophagus spread locoregionally through the extensive submucosal lymphatic plexus or distantly through hematogenous routes.

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9
Q

What histologies predominate based on the tumor location within the esophagus?

A

The proximal three-fourths of the esophagus (Cx to midthoracic) are mostly SCCs (∼30%–40%), whereas adeno generally is found in the distal esophagus (∼60%–70%).

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10
Q

What more uncommon histologies are seen for tumors of the esophagus?

A

Adenocystic, mucoepidermoid, small cell, and sarcomatous (leiomyosarcoma) carcinomas (all typically ≤1% of cases). Extremely rare types are lymphoma, Kaposi sarcoma, and melanoma.

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11
Q

What are the common sites of DM seen for esophageal cancers?

A

Lung, liver, and bone are the most common sites of DM. (Xi M et al., Radiother Oncol 2017)

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12
Q

What is the most important factor that determines nodal mets and DM?

A

DOI is the most important factor dictating nodal and distant spread. (Mariette C et al., Cancer 2003)

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13
Q

What is the extent of submucosal spread of Dz seen for esophageal cancers, and does it differ by histology?

A

Gao XS et al. reported the following for SCC: mean microscopic proximal and distal spread beyond GTV of 10.5 ± 13.5 mm and 10.6 ± 8.5 mm, respectively, with 94% of pts having all tumor contained within a 30-mm margin. For adeno, mean spread of Dz is to 10.3 ± 7.2 mm proximally and 18.3 ± 16.3 mm distally, with a margin of 50 mm required to encompass all tumor in 94% of cases. (IJROBP 2007)

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