Esophageal cancer Flashcards
What are the 2 major subtypes of oesophageal cancer?
Squamous cell carcinoma (most common)
Adenocarcinoma
Name risk factors for oesophageal SCC
Smoking Alcohol Diet Recurrent thermal injury Nitrosamines Caustic injury HPV RT Esophageal candidiasis Tylosis Plummer-Vinson syndrome Diverticula Achalasia
Name risk factors for oesophageal adenocarcinoma
Smoking Obesity Male Older GERD Barret's
What is the localization of oesophageal adenocarcinoma?
Lower 1/3
What is the localization of oesophageal SCC?
Upper 2/3
Name typical symptoms of oesophageal cancer
Progressive dysphagia (solids to fluids) Weight loss Anorexia Fatigue Vomit blood Malena stools
Name symptoms of local invasion of oesophageal cancer
Coughing, choking, recurrent pneumonia (TOF)
Hoarseness
How is dysphagia graded?
Mellow and Pinkas
Give the Mellow and Pinkas dysphagia grading scale
0 - able to eat normally 1 - able to swallow some solids 2 - able to swallow only semi-solids 3 - able to swallow only liquids 4 - unable to swallow anything
Name signs of metastases in oesophageal cancer
Constitutional symptoms Jaundice Hepatomegaly Virchow's node Pleural effusions
Name the most common sites of oesophageal cancer metastasis
LN Lung Liver Bones Brain Adrenal glands Peritoneum
Name investigations in oesophageal cancer
Barium swallow
Endoscopy and biopsy
General: Bloods CXR ECG Echo Lung function test
Staging: CT Endoscopic U/S PET Staging laparoscopy
Name features of oesphageal cancer on Barium swallow
Apple core stricture Shouldering Proximal dilation Axis deviation/angulation TOF
What tumour characteristics should be documented at endoscopy?
Site Length of lesion Circumferential involvement Obstruction Adjacent lesions
How is oesophageal cancer staging classified?
AJCC TNM classification
Give the AJCC TNM classification
Tis - high grade dysplasia
T1a - invades lamina propria/muscularis mucosa
T1b - invades submucosa
T2 - invades muscularis propria
T3 - invades adventitia
T4a - invades adjacent structures (pleura, pericardium, azygos vv, diaphragm, peritoneum)
T4b - invades major adjacent structures (aorta, vertebrae, trachea)
N0 - none
N1 - 1-2 nodes
N2 - 3-6 nodes
N3 - >6 nodes
Discuss the management of oesphageal lesions confined to the mucosa
Local ablation
Discuss the management of oesphageal lesions confined to the oesophagus
Surgical resection with adjacent lymph nodes
Discuss the management of locally advanced resectable oesophageal lesions
Surgery
Adjuvant chemoradiotherapy
Discuss the management of locally advanced irresectable oesophageal lesions
Palliation
- dysphagia
- analgesia
- chemotherapy
Discuss the management of cervical tumours
Definitive CRT with curative intent
When can oesophagectomy be considered?
Complete resection with clear margins and all positive nodes possible
Name unfavourable factors for oesophagectomy
Long tumours >8cm
Nerve involvement
Fistula
Pleural effusion
Name the types of surgical resection
Trans-hiatal
Two-stage (Ivor-Lewis)
Three-stage (McKeon)
