Cancer of Oesophagus

Question 1

State the incidence of Oesophageal Cancer.

Answer 1

80% develop over age of 60.

Question 2

State a risk factor for Oesophageal Cancer.

Answer 2

1) Lifestyle factors e.g. obesity, smoking, alcohol, achalasia (muscular ring that closes off oesophagus from stomach).
2) Barrett’s oesophagus (reflux causing).
3) Radiotherapy

Question 3

Define Metaplasia.

Answer 3

Occurs in Barrett’s oesophagus - when mature differentiated cell transforms into new mature cell type.

Question 4

Define Dysplasia.

Answer 4

Occurs in Barrett’s oesophagus - when tissue develops a large number of immature cells to become

Question 5

State a type of Carcinoma of the Oesophagus.

Answer 5

Adenocarcinoma. Squamous Carcinoma.

Question 6

Define an Adenocarcinoma of the Oesophagus.

Answer 6

Lower oesophageal mucosa damaged by the reflux of acid and gastric content in hiatus hernia. Results in metaplasia (Barrett’s oesophagus), progresses to dysplasia and adenocarcinoma.

Question 7

Where does a Squamous Carcinoma arise from in Oesophageal Cancer?

Answer 7

Arises from a Squamous Carcinoma.

Question 8

Define Barrett’s Oesophagus.

Answer 8

Is the condition in which there is an abnormal (metaplastic) change in the mucosal cells lining the lower portion of the oesophagus. It’s caused by chronic inflammation.

Question 9

State a symptom of Oesophageal Cancer.

Answer 9

Difficulty swallowing. Persistent heartburn. Weight loss. Pain in throat/behind the sternum. Regurgitation of food.

Question 10

State an investigation of Oesophageal Cancer.

Answer 10

Oesophagoscopy - camera with a biopsy for staging. Blood tests (full blood count, urea and electrolytes, liver function tests). Staging CT scan (chest, abdomen and pelvis).

Question 11

State a treatment for Oesophageal Cancer.

Answer 11

1) Endoscopic therapy for early cancer with mucosa - Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Resection (ESD).
2) Chemotherapy - neo-adjuvant chemotherapy before treatment (surgery), peri-operative chemotherapy.
3) Surgery - Oesophagectomy
4) Palliative for Advanced Cancer

Question 12

State a type of chemotherapy.

Answer 12

Combination of 2 drugs. Combination of 3 drugs. Advanced Cancer.

Question 13

Define Chemotherapy - combination of 2 drugs.

Answer 13

Cisplatin + Fluorouracil (SFU). Cisplatin + Capecitabine (CX).

Question 14

Define Chemotherapy - combination of 3 drugs.

Answer 14

Epirubicin + Cisplatin + Capecitabine (ECX). Epirubicin + Oxaliplatin + Capecitabine (EOX).

Question 15

Define Chemotherapy - advanced cancer.

Answer 15

Trastuzumab (herceptin) - if HER2 protein expression. Epirubicin + Cisplatin + Fluorouracil (ECF).

Question 16

State an example of a Chemotherapy drug.

Answer 16

Carboplatin (Paraplatin). Paclitaxel (Taxol).

Question 17

Define an Ivor-Lewis Oesophago-gastrectomy.

Answer 17

Middle and lower third of oesophagus removed.

Question 18

Define what Palliative care for Advanced Cancer involves.

Answer 18

Radiotherapy/chemotherapy. Stenting if obstruction.

Question 19

Define T1 for Oesophageal Cancer.

Answer 19

Cancer in the mucosa/submucosa layer.

Question 20

Define T2 for Oesophageal Cancer.

Answer 20

Cancer involves the muscular layer.

Question 21

Define T3 for Oesophageal Cancer.

Answer 21

Cancer involves the serosa layer of the membrane.

Question 22

Define T4a for Oesophageal Cancer.

Answer 22

Cancer involves the pleura, pericardium and diaphragm.

Question 23

Define T4b for Oesophageal Cancer.

Answer 23

Cancer involves the trachea, vertebra and aorta.

Question 24

Define T4 for Oesophageal Cancer.

Answer 24

The cancer has grown into another body structure.

Question 25

Define N0 in Oesophageal Cancer.

Answer 25

No lymph nodes.

Question 26

Define N1 in Oesophageal Cancer.

Answer 26

1 or 2 nearby lymph nodes.

Question 27

Define N2 in Oesophageal Cancer.

Answer 27

3 to 6 nearby lymph nodes.

Question 28

Define N3 in Oesophageal Cancer.

Answer 28

7 or more nearby lymph nodes.

Question 29

Define M0 in Oesophageal Cancer.

Answer 29

No spread.

Question 30

Define M1 in Oesophageal Cancer.

Answer 30

Spread to other parts.

Question 31

What is meant by staging?

Answer 31

How much the carcinoma has spread?

Question 32

Define stage 0 of Oesophageal Cancer.

Answer 32

High grade dysplasia.

Question 33

Define stage 1A of Oesophageal Cancer.

Answer 33

Cancer of the submucosa layer.

Question 34

Define stage 1B of Oesophageal Cancer.

Answer 34

Cancer of the muscular layer.

Question 35

Define stage 2A of Oesophageal Cancer.

Answer 35

Cancer of the outside of the Serosa (membrane covering the oesophagus outside of muscles).

Question 36

Define stage 2B of Oesophageal Cancer.

Answer 36

Cancer involves the muscles and 1-2 lymph nodes.

Question 37

Define stage 3A of Oesophageal Cancer.

Answer 37

T4a, N0, M0 = Cancer involves the pleura, pericardium or diaphragm. T3, N1, M0 = Cancer involves the serosa, 1-2 lymph nodes. T1/2, N2, M0 = Cancer involves the muscles, nearby 3-6 lymph nodes.

Question 38

Define stage 3B of Oesophageal Cancer.

Answer 38

T3, N2 (3-6 lymph nodes), M0

Question 39

Define stage 3C of Oesophageal Cancer.

Answer 39

T4a, N1 or 2, M0 = Involves 6 lymph nodes pleura, heart or diaphragm T4b, any N, M0 = Involves the trachea, vertebra or aorta and lymph nodes Any T, N3, M0 = Involves more than 7 lymph nodes

Question 40

Define stage 4 of Oesophageal Cancer.

Answer 40

Distance metastases e.g. liver or lungs.

Question 41

State the prognosis or a Squamous Cell Carcinoma.

Answer 41

75% survival 1 year or more.

Question 42

State the prognosis or a Adenocarcinoma.

Answer 42

75% survival 1 year or more.

Question 43

State the prognosis of Cancer spread to lymph nodes.

Answer 43

21% live for more than 5 years.

Question 44

State the prognosis of Advanced Oesophageal Cancer (distant metastases).

Answer 44

Most live for 3 to 12 months.