Esophageal Cancer Flashcards
MC histologic type of esophageal cancer worldwide
SCC
RF for esophageal SCC
- EtOH
- Tobacco (100-fold increased risk when combined with EtOH)
- Dietary factors:
- nitrosamines
- high-cholesterol consumption
- Achalsia
- Plummer-Vinson syndrome
- HIV
- EBV
Esophageal SCC more common in men or women
Men (2:1 - 3:1 M:F ratio)
MC esophageal location for SCC
MIddle 1/3 of esophagus
Most common histologic type of esophageal cancer in United States
Adenocarcinoma
(fastest growing solid malignancy in US)
Etiologic hypothesis for deveopment of esophageal adenocarcinoma
Metaplasia-Dysplasia-Carcinoma sequence in Barrett’s epithelium related to GERD (especially long-segment disease)
RF for esophageal adenocarcinoma
- Barrett’s esophagus (GERD)
- Nitrates
- Obesity
- Smoking
- LES relaxing drugs
- Mixed bile-acid reflux
- TP53 gene mutations
- Chronic esophageal inflammation
MC esophageal location of adenocarcinoma
Distal esophagus
Classic presentation of esophageal cancer
Dysphagia to solids
Typical patient with esophageal adenocarcionoma
- Middle aged male
- Middle-High SES
- Long history of GERD with known hital hernia
- No weight loss
- No palpable LN
Typical patient with esophageal SCC
- Heavy EtOH and cigarette use
- Low SES
- Few months of dysphagia and weight loss
- Odynophagia, hemoptysis and horseness (may be present)
Diagnostic modalities used for esophageal cancer
- Barium swallow esophagography
- Flexible endoscopy with brushings and multiple bx
- EUS/FNA (staging with LN biopsy)
- PET (staging and eval for metastatic disease)
T-stage for esophageal cancer determined by what modality
EUS
Five EUS esophageal layers used in T-staging for carcinoma
- First layer: mucosa (hyperechoic)
- Second layer: deep mucosa (hypoechoic)
- Third layer: submucosa (hyperechoic)
- Fourth layer: muscularis propria (hypoechoic)
- Fifth layer: adventitia (hyperechoic)
Esophageal carcinoma T-stages
- T1: layers 1-3 (up to submucosa)
- T1a: Tumor invades the lamina propria or muscularis mucosa
- T1b: Tumor invades the submucosa
- T2: layer 4 (muscularis propria)
- T3: layer 5 (beyond muscularis propria into adventitia)
- T4: beyond layer 5 with obliteration of fat planes surrounding esophagus
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Features of LN used to define TNM (N stage) for esophageal cancer
- Intrathoracic or intraabdominal LN > 1cm
- Supraclavicular LN > 0.5 cm
- Cervical or celiac LN: M disease
Anatomic sites of esophageal carcinoma metastasis
- Liver (35%)
- Lung (20%)
- Bone (9%)
- Adrenals (2%)
- Brain (2%)
- Pericardium
- Pleura
- Soft tissues
- Stomach
- Pancreas
- Spleen
Two MC sites of esophageal carcinoma metastasis
Liver (35%)
Lung (20%)
Non-surgical treatment options for early stage I esophageal carcinoma
- Endoscopic mucosal resection (EMR)
- Photodynamic therapy (PDT)
- Laser ablation
Rate of LN positivity for T1a (mucosal) esophagel cancer
0-12%
Rate of LN positivity for T1b esophageal cancer
25-40%
Histopathologic features important in determining prognosis for esophageal cancer
- LN status
- Multifocal neoplasia
- Skip lesions
- Lymphovascular invasion
Indicatations for esophagectomy
Absence of regional (N) or distant (M) disease (single modality therapy)
Indications for multimodality therapy for esophageal cancer
Advanced stage (N or M disease)
Esophagectomy that avoids the pulmonary morbidity of thoracotomy
Transhiatal esophagectomy