Chapter 41: Esophageal Cancer

Question 1

Identify which type of esophageal cancer is the most common.

Answer 1

Adenocarcinomas

Question 2

Identify key risk factors for developing esophageal cancer. (6)

Answer 2

1. Between 65-75yo
2. Male
3. BE
4. Smoking (second hand smoke exposure)
5. Injury to the esophageal mucosa (eg occupational exposure)
6. Achalasia: condition of delayed emptying of the lower esophagus

Question 3

Describe clinical manifestations of esophageal cancer. (4)

Answer 3

1. Progressive dysphagia
   * Most common
   * Substernal feeling that food isn’t passing
   * (initially occurs only with foods like meat, soft foods, then liquids)
2. Pain with swallowing: substernal, epigastric, or back; radiates to the neck, ears, jaw and shoulders
3. Wt loss
4. Regurgitation (with stenosis) of blood flecked esophageal contents

Question 4

Describe potentially major complications that occur due to presence of an esophageal tumor. (3)

Answer 4

*Hemorrhage: when cancer erodes the esophagus and into the aorta
*Perforation: w/ fistula formation into the lung and trachea
*Obstruction: if tumor is enlarged and blocks the esophagus (later stages)

Question 5

Cite which diagnostic procedure is needed to confirm esophageal cancer. (2)

Answer 5

*Endoscopy
*The EUS and barium swallow

Question 6

Explain what is meant by a multimodal approach to treat esophageal cancer. (3)

Answer 6

*Best approach
*Utilizes surgery, endoscopic ablation, chemo, and radiation
*Depends on the location and spread of the cancer

Question 7

Name 2 factors help guide the treatment of esophageal cancer.

Answer 7

Location and spread of cancer

Question 8

Describe surgical therapies to treat esophageal cancer. (3)

Answer 8

1. Esophagectomy with Dacron graft: removal of part or all of the esophagus and replacing the resected part with the graft.
2. Esophagogastrostomy: resection of a portion of the esophagus and anastomosis of the remaining portion of the stomach.
3. Esophagoenterostomy: resection of a portion of the esophagus and anastomosis of a segment of the colon to the remaining portion

Question 9

Describe endoscopic therapies to treat esophageal cancer. (3)

Answer 9

1. Photodynamic therapy: IV porfimer sodium and photosensitizer which is absorbed by the CA tissue
2. endoscopic mucosal resection (EMR): option for small early stages involves removing the CA tissue using an endoscope
3. radiofrequency ablation: Book just mentions this with no real explanation lol

Question 10

Describe assessment data that could indicate presence of esophageal cancer. (subjective vs objective)

Answer 10

1. Subjective: ask about health hx (GERD, hiatal hernia, achalasia, BE, and tobacco or alcohol use). Ask about substances that cause dysphagia (meats, soft foods, liquids).
2. Objective: progressive dysphagia and odynophagia (burning, squeezing pain while swallowing), pain (substernal, epigastric, or back area), choking, hoarseness, coughing, anorexia, wt loss, and regurgitation

Question 11

List 5 possible nursing diagnoses and expected outcomes for patients with esophageal cancer.

Answer 11

1. Chronic pain
2. Impaired nutritional intake
3. Impaired nutritional status
4. Risk for aspiration
5. Anxiety