Esophageal Cancer Flashcards
What are the risk factors for esophageal cancer (9)?
- smoking and tobacco use
- alcohol use
- chronic reflux
- Barrett’s
- high fat, high calorie, low protein diet
- tylosis
- Plummer Vinson
- achalasia
- obesity
People who are __ years of age have the highest incidence of esophageal cancer.
50-70
Is esophageal cancer more common in men or women?
Men! 3-4x!
What ethnic group has the lowest incidence of esophageal cancer?
Pacific Islanders and Asians
What is tylosis?
genetic disorder involving thickening of the skin of the palms and soles, along with oral leukoplakia
What three things does Plummer Vinson syndrome involve?
dysphagia
esophageal webs
iron deficiency anemia
What is achalasia?
esophageal motility disorder
signs and symptoms of esophageal cancer (7)
dysphagia = difficulty swallowing odynophagia = painful swallowing weight loss pain cough hematemesis/melena dysphonia = impaired ability to produce vocal sounds
What is the earliest sign of esophageal cancer?
dysphagia
Adenocarcinoma of the esophagus involves what part? What is it associated with?
Adenocarcinoma involves the distal esophagus and is associated with Barrett’s.
Squamous cell carcinoma of the esophagus involves what part? What is it associated with?
upper 1/3
alcohol and tobacco use
What work up would we do on a patient with suspected esophageal cancer?
First is the history and PE. Then, we would do the following: 1) lab evaluation to check CBC, electrolytes, BUN, creatinine, liver function, CEA, PT/PTT, 2) barium swallow to look for masses, 3) CT chest/abdomen/pelvis, 4) esophagogastroduodenoscopy (EGD) + biopsy, 5) PET (like CT, checks for size and mets), 6) EGD and endoscopic US (to check for lymph involvement and invasion extent)
What helps us determine the TNM?
T = EGD/EUS N = EGD/EUS M = CT/PET
Who determines the grade of the tumor?
pathologist
Describe T1-T4.
Early stage/localized would be a tumor in situ, T1 and any N. Regional or locally advanced would be T2-T4, and any N.
What do we do if the patient shows mets?
supportive care and systemic therapy like chemo if the patient can handle it
If there is no metastatis, what test do we run to determine if it is early stage/localized or regional/locally advanced?
EGD/EUS
treatments for early stage esophageal cancer
endomucosal resection
esophagectomy
treatments for regional esophageal cancer
like with early stage, could also do esophagectomy
definitive chemoradiation
chemoradiation + esophagectomy
chemotherapy, chemoradiation, + esophagectomy
What are some long term effects for treatment of esophageal cancer and their solutions?
reflux, early satiety, malnutrition/weight loss from surgery
esophagitis and strictures from radiation
fatigue and peripheral neuropathy from chemo
T/F: Early stage can be treated with local therapies or surgery alone.
True
Is metastatic esophageal cancer curable?
No! Chemotherapy is the mainstay of therapy.
