esophageal CA Flashcards
esophageal cancer types
squamous cell and adenocarcinoma
epidemiology of esophageal CA
squamous cell predominates worldwide
adenocarcionma rates incr. in US- now 70% of all new cases. predominates in males
risk factors for esophageal CA
old age, smoking, and male race: both
squamous cell: alcohol (and tobacco: top 2), Af. American, lye ingestion, achalasia, ingestion of very hot liquids, Plummer-Vinson syndrome/(esophageal web, iron deficiency anemia, dysphagia), tylosis (autosomal dominat skin condition resulting in palmar and plantar skin thickening and high risk of esophageal CA). these risk factors suggest that this is contact injury
Adenocarcinoma: GERD, barrett’s esophagus, white, high BMI
esophageal CA presentation
solid food dysphagia that is often progressive over just a few wks.
odynophagia, weight loss, epigastric painm chest pain.
potentially cough/hoarse voice.
diagnosis of esophageal CA
EGD with biopsy (esophagogastroduodenoscopy). Barium swallow gives suggestion of a tumor
staging of esophageal CA
TNM staging.
T: depends on depth of the tumor. these cancers start on the inner most lining of the esophageal lumen. T1: submucosa at most; T2: in muscularis propria; T3: through muscularis propria; T4: into adjacent structure
N: number of involved lymph nodes
M: mets present or absent.
Grade and location matter in squamous cell management. Surgery is better if tumor is lower in the esophagus
grade is considered in management of adenocarcinoma (though less important than in squamous)
What should I know about stage at presentation of esophageal cancers?
often late stage (stage II or further) at presentation due to rapid growth of cancer and the copious lymph drainage.
tests for staging esophageal CA
CT +/- PET done in most cases to look at staging.
CT shows tumor invasion into other structures. less good at looking for mets/nodes. PET good for met identification.
tumors that are small endoscopically or do not shw mets/invasion of adjacent structures on CT or PET scans can be evaluated by endoscopic ultrasound +/- LN fine needle biopsy.
endoscopy with biopsy is used to show histology, grade, size, and length
What should I know about prognosis of esophageal cancer?
Even at stage I, survival only 80%
Stage II: 30-40% 5 yr survival
Stage III: 15% survival
Stage IV: less than 5%
esophageal CA Tx: stage I
usually by surgical excision, potentially even by endoscopic mucosal resection (EMR). EMR also helpful for evaluation of T stage. these pts are in the minority at presentation.
esophageal CA tx: stages II and III
if surgical candidates, do trimodal therapy. pre-operative neoadjuvant therapy with radiation treatments AND chemotehrapy to shrink tumor size, followed by surgery in pts whos restaging eval shows a response.
if not a surgical candidate, give chemo and radiation.
esophageal CA tx: stage IV
palliative. may give palliative radiation/chemo. address nutrition early.
When should we screen for Barrett’s esophagus?
pts with multiple risk factos associated with adenocarcinoma of the esophagus. if no dysplasia, screen again in 3-5 yrs. If low grade dysplasia, screen in 6-12 mo. If high grade dysplasia, do endoscopic ablation and eradication.
contraindications to surgery in esophageal CA
mets to solid organs
mets to cerival, celiac, supraclavicular lymph nodes
severe comorbidities
patient refusal
