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Cameron's Esophagus and Spleen > Esophageal Cancer > Flashcards

Esophageal Cancer Flashcards

1
Q

What is the most common esophageal cancer?

A

Adenocarcinoma (formerly the most common type was squamous cell carcinoma)

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2
Q

What are the most important risk factors for the development of squamous cell carcinoma of the esophagus?

A

Smoking and alcohol

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3
Q

What are the predominant risk factors associated with the development of adenocarcinoma of the esophagus?

A

Barrett’s esophagus and long standing GERD

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4
Q

What is the most common presenting symptom of esophageal cancer?

A

Dysphagia

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5
Q

What is included in the preoperative evaluation for esophageal cancer?

A

Determining extent of disease and patients clinical status. Upper endoscopy, CT scan, PET and EUS.

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6
Q

What is the role of CT scan in esophageal cancer?

A

For detection of metastatic disease.

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7
Q

Is transhiatal approach to esophageal cancer the only effective option?

A

No, Ivor-Lewis is a combined thoracic and abdominal dissection with complete lymphadenectomy, and eliminates risk of a blind thoracic dissection.

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8
Q

True or False: Small intestine interposition is the simplest method for esophageal reconstruction in esophageal cancer.

A

False. Small bowel interposition is the most complex method of reconstruction, requiring microvascular and intestinal anastomoses.

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9
Q

Which interposition grafts are preferred for benign disease?

A

Colonic

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10
Q

True or False: A gastric pullup is the most popular method of esophageal reconstruction.

A

True. It requires only a single anastomosis, has enough length to reach the neck, and serves as an effective alimentary conduit.

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11
Q

True or False: The detection of high grade dysplasia (HGD) in BE is an indication for esophagectomy.

A

True. HGD is a marker of occult adenocarcinoma. Presence of occult adenocarcinoma in resected specimen approaches 50%.

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12
Q

How does treatment differ in patients with small, visible mucosal lesions of high grade dysplasia in Barrett’s?

A

Endoscopic mucosal resection (EMR) is an option, and adequate therapy if area is less than 20mm in diameter and cancer is confined to the lamina propria.

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13
Q

Treatment for disease that invades the muscularis mucosa or extends into submucosa.

A

En bloc esophagectomy, because are locally advanced disease.

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14
Q

What is the risk of nodal metastasis in esophageal cancers limited to mucosa?

A

3-6%

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15
Q

What is the risk of nodal metastasis in esophageal cancers penetrating the submucosa?

A

30%

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16
Q

What are the recommendations for resection in patients with esophageal cancers penetrating the muscularis mucosa?

A

Esophagectomy, lymphadenectomy.

17
Q

Do esophageal tumors invading the lamina propria require lymphadenectomy?

A

No. Recommendations include sparing vagal esophagectomy.

18
Q

In nonmetastatic locally advanced esophageal cancer, which surgical approach has less incidence of local recurrence?

A

En bloc

19
Q

True or False: Transhiatal esophagectomy has a better overall survival than en bloc resection for esophageal cancer.

A

False, transhiatal resection has survival of 25% for all stages compared to en bloc survival of 40-50% at 5 years.

20
Q

What are the two most important prognostic factors for survival in esophageal cancer?

A

tumor depth and nodal involvement

21
Q

Does number of nodes removed provide a survival benefit in patients with esophageal cancer?

A

Yes.

22
Q

Indications for surgery in metastatic esophageal cancer.

A

Palliation: esophageal perforation, bleeding and unsuccessful stent placement

23
Q

Followup after esophagectomy.

A

During first 3 years, every three months, then every 4-6 months.

24
Q

When is adjuvant chemotherapy employed in patients with esophageal cancer?

A

When there are four or more positive lymph nodes on histology of surgical specimen.

25
Q

Which procedure is utilized in palliative resection of esophageal cancer and why?

A

Transhiatal, because of less extensive dissection and fewer complications.

26
Q

Can esophageal stents be used in benign disease?

A

Yes

27
Q

Which patients are candidates for esophageal stent placements?

A
  1. Perforation of benign disease but unable to undergo surgery, 2. Late perforations 3. Perforation of malignant disease but unable to undergo surgery 4. Anastomotic leak after esophagogastrectomy, 5 Immediate recognition of iatrogenic perforation during endoscopy
28
Q

When stenting for benign disease, how long are most stents left in place?

A

2 months

29
Q

Name the early complications of stent placement

A

Early complications appear <30 days after stent placement and include chest pain, bleeding, aspiration, perforations, fistula and stent migration, stent obstruction.

30
Q

Name the common late complications of stent placement

A

Late complications appear >30 days after stent placement and are usually related to tumor progression. Tumor ingrowth or overgrowth leading to dysphagia, bleeding, ulceration, perforation, fistula, stent fracture and migration.

31
Q

What percentage of patients diagnosed with esophageal carcinoma present with metastatic disease?

A

50%

32
Q

What is overall survival for esophageal cancer?

A

About 20%

33
Q

Has neoadjuvant therapy shown a survival benefit in esophageal cancer?

A

Yes, neoadjuvant chemoradiotherapy provides a survival benefit for locally advanced esophageal carcinoma.

34
Q

What is the main blood supply to the gastric conduit?

A

Right gastroepiploic artery

Cameron's Esophagus and Spleen (13 decks)

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