Cancer of Oesophagus Flashcards
State the incidence of Oesophageal Cancer.
80% develop over age of 60.
State a risk factor for Oesophageal Cancer.
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
Define Metaplasia.
Occurs in Barrett’s oesophagus - when mature differentiated cell transforms into new mature cell type.
Define Dysplasia.
Occurs in Barrett’s oesophagus - when tissue develops a large number of immature cells to become
State a type of Carcinoma of the Oesophagus.
Adenocarcinoma. Squamous Carcinoma.
Define an Adenocarcinoma of the Oesophagus.
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.
Where does a Squamous Carcinoma arise from in Oesophageal Cancer?
Arises from a Squamous Carcinoma.
Define Barrett’s Oesophagus.
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.
State a symptom of Oesophageal Cancer.
Difficulty swallowing. Persistent heartburn. Weight loss. Pain in throat/behind the sternum. Regurgitation of food.
State an investigation of Oesophageal Cancer.
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).
State a treatment for Oesophageal Cancer.
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
State a type of chemotherapy.
Combination of 2 drugs. Combination of 3 drugs. Advanced Cancer.
Define Chemotherapy - combination of 2 drugs.
Cisplatin + Fluorouracil (SFU). Cisplatin + Capecitabine (CX).
Define Chemotherapy - combination of 3 drugs.
Epirubicin + Cisplatin + Capecitabine (ECX). Epirubicin + Oxaliplatin + Capecitabine (EOX).
Define Chemotherapy - advanced cancer.
Trastuzumab (herceptin) - if HER2 protein expression. Epirubicin + Cisplatin + Fluorouracil (ECF).
State an example of a Chemotherapy drug.
Carboplatin (Paraplatin). Paclitaxel (Taxol).
Define an Ivor-Lewis Oesophago-gastrectomy.
Middle and lower third of oesophagus removed.
Define what Palliative care for Advanced Cancer involves.
Radiotherapy/chemotherapy. Stenting if obstruction.
Define T1 for Oesophageal Cancer.
Cancer in the mucosa/submucosa layer.
Define T2 for Oesophageal Cancer.
Cancer involves the muscular layer.
Define T3 for Oesophageal Cancer.
Cancer involves the serosa layer of the membrane.
Define T4a for Oesophageal Cancer.
Cancer involves the pleura, pericardium and diaphragm.
Define T4b for Oesophageal Cancer.
Cancer involves the trachea, vertebra and aorta.
Define T4 for Oesophageal Cancer.
The cancer has grown into another body structure.
Define N0 in Oesophageal Cancer.
No lymph nodes.
Define N1 in Oesophageal Cancer.
1 or 2 nearby lymph nodes.
Define N2 in Oesophageal Cancer.
3 to 6 nearby lymph nodes.
Define N3 in Oesophageal Cancer.
7 or more nearby lymph nodes.
Define M0 in Oesophageal Cancer.
No spread.
Define M1 in Oesophageal Cancer.
Spread to other parts.
What is meant by staging?
How much the carcinoma has spread?
Define stage 0 of Oesophageal Cancer.
High grade dysplasia.
Define stage 1A of Oesophageal Cancer.
Cancer of the submucosa layer.
Define stage 1B of Oesophageal Cancer.
Cancer of the muscular layer.
Define stage 2A of Oesophageal Cancer.
Cancer of the outside of the Serosa (membrane covering the oesophagus outside of muscles).
Define stage 2B of Oesophageal Cancer.
Cancer involves the muscles and 1-2 lymph nodes.
Define stage 3A of Oesophageal Cancer.
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.
Define stage 3B of Oesophageal Cancer.
T3, N2 (3-6 lymph nodes), M0
Define stage 3C of Oesophageal Cancer.
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
Define stage 4 of Oesophageal Cancer.
Distance metastases e.g. liver or lungs.
State the prognosis or a Squamous Cell Carcinoma.
75% survival 1 year or more.
State the prognosis or a Adenocarcinoma.
75% survival 1 year or more.
State the prognosis of Cancer spread to lymph nodes.
21% live for more than 5 years.
State the prognosis of Advanced Oesophageal Cancer (distant metastases).
Most live for 3 to 12 months.
