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Cancer Quizzes > Esophageal Cancer > Flashcards

Esophageal Cancer Flashcards

1
Q

What is the definition of Etiology

A

The study of a cause of a disease/ illness

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2
Q

What is the definition of Epidemiology

A

Study of disease incidence

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3
Q

What are two types of oesophageal cancer

A
  • Adenocarcinoma
  • Squamous Cell Carcinoma
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4
Q

Describe the INCIDENCE of oesophageal cancer

A
  • 1% of all cancers
  • Men 3x more than women
  • 55 - 85 yrs old
  • Diagnosed at later stages
  • 5 year survival is less than 25%
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5
Q

What are risk factors of squamous cell oesophageal cancer?

A
  • Tobacco and Alcohol
  • Diet
  • Achalasia
  • Head and Neck Cancer
  • Tylosis, Coeliac disease and Lye ingestion
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6
Q

What are risk factors of adenocarcinoma oesophageal cancer?

A
  • Barrett’s oesophagus
  • Gastroesophageal reflux
  • GERD
  • Smoking
  • Overweight & Obesity
  • Diet (low fresh fruit & veggies, high in nitrates)
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7
Q

What is some basic anatomy of the oesophagus?

A
  • Average length is 25cm
  • Begins at C6, through thoracic cage
  • Ends at the esophageal gastric junction T10 - T11

  • Directly posterior to trachea
  • Anterior to the vertebral column
  • Laterally and to the left of the esophagus is the aortic arch.
  • Descending aorta is lateral and posterior to the esophagus
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8
Q

Esophageal Lymph Nodes

A
  • Upper thoracic esophagus: Internal jugular, cervical, paraesophageal and supraclavicular nodes
  • Middle thoracic esophagus: Paratracheal, hilar, subcarinal, paraesophageal, and paracardial nodes
  • Lower thoracic esophagus: Celiac axis, gastric nodes and nodes within the lesser curvature of the stomach
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9
Q

What is the most common route of spread?

A
  • Sub-mucosal spread is most common.
  • Spread is longitudinal.
  • Distant mets occurs with the liver and lung being most common.
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10
Q

What are symptoms of Oesophageal cancer?

A

Dysphagia (difficulty swallowing) & weight loss occurs in 90% of patients
Anorexia
Pain
Vomiting
Difficulty with food sticking in their throat or chest

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11
Q

How is Oesophageal cancer diagnosed?

A

Esophagoscopy (flexible endoscope used to examine the entire esophagus)
Barium swallow
Chest radiograph
Endoscopic ultrasound scan (EUS)
Bronchoscopy for upper & middle third lesions in the tracheobroncial tree.
CT scan of chest and upper abdomen
PET used with flurodeoxyglucos (FDG)

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12
Q

Why is staging important?

A

To define the extent of the primary lesion
To exclude metastatic disease
To quantify co-morbidity and assess suitability for therapy

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13
Q

Describe Stage 1 of oesophageal cancer?

A

T0 N0 M0
60% chance of 5 year survival

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14
Q

Describe Stage 2 of oesophageal cancer?

A

T2-3,N0 M0
31% of 5 year survival

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15
Q

Describe Stage 3 of oesophageal cancer?

A

T3 N1 M0
20% chance of 5 year survival

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16
Q

Describe Stage 4 of oesophageal cancer?

A

any T, any N, MI

4% chance of 5 year survival

17
Q

What is the histology of oesophageal cancer?

A

50% are squamous cell carcinomas
48% are Adenocarcinomas

The other 2% include: leiomyo-sarcoma, carcinoid, lymphoma, small cell carcinoma

18
Q

What are curative techniques for oesophageal cancer?

A

Surgery
Radiation Therapy
Combined therapy
- Chemo/RT

19
Q

What is the ideal for of treatment?

A

Surgery - resecting the tumor

20
Q

What are some reasons for surgical failures

A

High frequency of nodal involvement
Spread to surronding organs
Advanced at presentation (because it asymptomatic)
Patient is medically unfit for surgery
Patient refuses surgery

21
Q

How is the CERVICAL oesophagus treated?

A

The surgery for cervical oesophageal cancer is quite radical and involves removing the pharynx (loss of voice)
thus chemo and radiation are the most common treatments.
Treated like a Head and Neck cancer (shell)

22
Q

Who are the ideal candidates for chemo/radiation therapy

A

people with localised disease (who arent fit for surgery)
localised SCC - Very small tumours
people with upper third lesions

23
Q

What are the goals of palliative treatment in oesophageal cancer?

A

Restore or maintain swallowing
Manage pain
Prevent bleeding

24
Q

What are common dose fractionations

A

60-65 Gy for XRT alone

41.4-50.4 Gy total dose for Pre op XRT & chemo at 1.8 - 2.0 Gy per fx

25
Q

What are organs at risk with the oesophagus

A

Lung
Heart
Spinal cord
Kidneys
Liver

26
Q

What are acute side effects of treatment

A

Lethargy
Skin erythema
Dysphagia - difficulty swallowing
Odynophagia - painful swallowing
Risk of neutrpaeni sepsis
Percarditis - inflammation of pericardium

27
Q

What are long term side effects of treatment

A
  • Stenosis or Stricture from scar formation
  • Transverse myelitis, should not occur of XRT are delivered and planned correctly
28
Q

Esophageal lesions generally include: (PTV)

A
  • CTV: Regional lymphatics, 3 - 4cm margin above and below the GTV & 1 cm radial margins
  • Lymph nodes: 0.5 cm - 1.5 cm from the GTV
  • PTV: Additional 0.5 - 1 cm for radial or lateral margins
29
Q

Common treatment techniques:

A
  • 3D conformal fields (AP/PA with oblique fields for a boost, or laterals)
  • Step and shoot IMRT
  • VMAT
  • The technique chosen is dependent on the location of the esophageal cancer, proximal versus distal, and which technique mini- mizes the dose to organs at risk.
30
Q

What lymph node regions are at risk

A
  • Cervical
  • Supraclavicular (Proximal lesions)
  • Mediastinal
  • Paraesophageal
  • Subdiaphragmatic (celiac axis)

Cancer Quizzes (2 decks)

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