ESOPHAGEAL CANCER Flashcards
do men or women get esophageal cancer more?
MEN
what age population do you see this in?
6th to 7th decade of life
increase risk with age
what are the 3 types of esophageal cancer
SCC
adenocarcinoma
metastatic caner
what kind of esophageal cancer is most common worldwide?
SCC
what race is SCC more common in?
blacks and asians
what kind of esophageal cancer is most common in the US?
adenocarcinoma
(Accounts for 2/3 esophageal carcinoma cases)
increasing incidence
what race is adenocarcinoma more common in?
whites
what percent of esophageal cancer does metastatic account for?
3%
what are the 2 cancers most likely to metastasize?
melanoma and breast cancer
what are the sx of esophageal cancer in early stages?
asx
when does DYSPHAGIA occur in esophageal cancer?
when constriction of esophageal lumen is <13 mm
what is a huge tell tale sign of esophageal cancer related to dysphagia?
PROGRESSIVE DYSPHAGIA: starts with solids-> semi solids-> liquids and/or saliva
what sx is present in almost all cases despite good appetite?
weight loss
its cancer…duh
what is another huge sx of esophageal cancer?
ODYNOPHAGIA
what are the OTHER sx of esophageal cancer besides the big 3?
- chest pain- pressure of burning pain that radiates to the back
- GI bleed
- vocal cord paralysis and hoarseness d/t compression of recurrent laryngeal nerve
- dyspnea- malignant pleural effusion or pulmonary metastasis
what is the most common malignant tumor in the proximal 2/3 of the esophagus?
SCC
what is an early lesion of SCC?
friable tissue, erythema, and erosions
what is an advanced lesion of SCC?
infiltrating or ulcerated mass, may be circumfrential
what are the BIG 3 (ONLY 3) RF for SCC?
- ALCOHOL
- tobacco use (in any form)
- HPV infection
what is the most common malignant tumor in the distal 1/3 of the esophagus?
adenocarcinoma of the esophagus
what does adenocarcinoma of the esophagus most often arise from?
barrett’s esophagus
in short, what is barrett’s esophagus?
a condition brought on by chronic GERD and reflux esophagitis
what is an early lesion of adenocarcinoma of the esophagus?
mucosal irregularities, ulcer, or nodule
what is an advanced lesion of adenocarcinoma of the esophagus?
ulcerated or exophytic mass with obstruction
what are the BIG 3 (ONLY 3) RF for adenocarcinoma of the esophagus?
- GERD!!
- tobacco use (in any form)
- obesity (central fat distribution)
what is the dx study of choice to identify the cancer?
endoscopy with brush cytology and biopsy
what is the dx study of choice to determine tumor extent?
CT chest and abdomen
what is the dx study of choice to determine the depth of the tumor in the esophageal wall and regional lymph node involvement?
endoscopic ultrasound of the esophagus
what basic blood tests should be run?
- CBC w/ diff
- electrolytes
- liver function
what does esophageal cancer tx depend on?
tumor staging, size, and location
what is TNM staging classification?
0-IV
what is the best tx for esophageal cancer?
surgical resection, often combined with chemotherapy for advanced cancers
what is the best tx for a tumor of ADVANCED age?
immunotherapy plus chemotherapy
what is T1 tumor staging?
mucosa and submucosa
what is T4 tumor staging?
lymph nodes involved
what does prognosis depend on?
tumor stage
what is the overall prognosis of esophageal cancer?
overall survival is poor d/t patients presenting w/ advanced disease
what has a 80% survival rate?
cancer restricted to mucosa
what has a <50% survival rate?
cancer with submucosal involvement
what has a -20% survival rate?
cancer w/ extension to muscularis
what is the 5 year survival of esophageal cancer?
<5%
what are the best prevention options?
- drink alc in moderation or not at all
- dont smoke
- maintain healthy weight
- manage acid reflux and other throat irritants
- eat healthy diet rich in fruits and veggies
- avoid drinking very hot liquids
compare and contrast the epidemiology, location, and RF for esophageal adenocarcinoma and SCC.
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