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General surgery > Esophageal cancer > Flashcards

Esophageal cancer Flashcards

1
Q

Risk factors

A 
Diet
Alcohol
Smoking
Achalasia
Plummer vinson syndrome
Obesity
Low vitamin A and C
Nitrosamine
Reflux
Barretts
Male
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2
Q

Location

A

Most common in middle 50%
Upper 20%
Lower 30%

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3
Q

Type

A

Adenocarcinoma

SCC

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4
Q

Clinical features

A

Dysphagia
Weight loss
Retrosternal chest pain

Hoarseness, cough

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5
Q

Investigations

A
  1. Oesophagoscopy w/ biopsy
  2. USS
  3. CT/PET CT
    Barium swallow
    CXR
    Staging laparoscopy if significant infra-diaphragm component

If limited food intake must assess nutritional status

  1. UEC
  2. LFTs, albumin, iron/folate
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6
Q

Management

A
  1. Non-operative
    Stenting, ablation, polypectomy, phototherapy
    Neoadjuvant chemoradiation: cisplatin + 5FU
  2. Operative
    Lewis tanner: intrathoracic esophagogastric anastamosis
    Transhiatal
    Esophagectomy
  3. Nutritional management
    If required feeding access
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7
Q

Contraindications to operative

A

Metastasis

Infiltration of tracheal/bronchial/aorta

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8
Q

Risk analysis for surgery

A

++Cardiopulmonary statu
Must cease smoking
Chest physioT
Optimise nutrition

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9
Q

Complications of operative management

A 
1. Medical
Cardiac- Failure, MI, arrythmias
Respiratory- sputum retention, bronchopneumonia, effusion, PE, pneumothorax, atelectasis
Hepatic/renal failure, stroke
2. Surgical
Hemorrhage
Fistula
Stricture
Obstruction
Tracheo-bronchial damage
Leak
Herniation
Infection
Empyema
Abscess
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10
Q

Staging and options for management

A 
T0 CIS
T1 Invading lamina P/submucosa
T2 muscularis propria
T3 Adventitia
T4 Invasion adjacent

N0 none
N1 regional nodes

M0 none
M1 mets

Stage 1-2 Resectable->radical esophagectomy
Stage 3 Locally advanced not resectable: chemoradiation with Epirubicin, cisplatin and 5FY
Stage 4/Mets: Palliation->Stent, chemoT, brachyT, phytoT

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11
Q

Is adenocarcinoma increasing

A

Yes->increase in GORD and barretts

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12
Q

Siewart classification of GE junction adenocarcinomas and surgical treatment

A
  1. Type I tumors are located more than 1 cm above the GE junction (surgical treatment would generally consist of esophagectomy)
  2. type II tumors are located within 1 cm proximal and 2 cm distal to the GE junction (surgical treatment would consist of esophagectomy with partial resection of the proximal stomach)
  3. Type III tumors are located more than 2 cm distal to the GE junction (surgical treatment would consist of total gastrectomy).
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13
Q

5 year survival

A

Stage 1 75-80
Stage 2 35-40
Stage 3 10-15
Stage 4 0

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14
Q

Stent advantage and disadvantage

A
  1. Advantages: Rapid relief of dysphagia; treatment of choice for tracheoesophageal fistula; short procedural time; outpatient procedure
  2. Disadvantages: Recurrence due to stent migration, tumor overgrowth, food impaction; transient pain following placement; gastroesophageal reflux; and increased risk of late hemorrhage
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15
Q

Phtodynamic therapy advantages and disadvantages

A

Endoluminal destruction of obstructing lesions

  1. Advantages: Works well with exophytic lesions; generally low complication rates
  2. Disadvantages: Often available only in specialized centers; special expertise required; repeat treatment every 4-8 weeks is needed
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16
Q

Brachytherapy advantages and disadvantages

A

Intraluminal radiotherapy

  1. Advantages: Long-term dysphagia improvement is better than stent placement; long-term quality-of-life score was better when compared with stent placement; lower rate of hemorrhage than stent placement
  2. Disadvantage: Dysphagia relief is delayed in comparison to stent placement
17
Q

Chemotherapy advantages and disadvantages

A
  1. Advantages: Treatment improves median survival; responders may have improved quality of life due to relief of obstruction
  2. Disadvantages: Response to obstruction is variable; therefore, additional treatment for obstruction may be needed; relief from obstruction may be delayed
18
Q

Risk factors of SCC

A

Tobacco
Alcohol
Chemical burns

General surgery (36 decks)

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