Esophageal cancer

Question 1

what causes oesophageal for both types of SCC and ACcancer ?

Answer 1

being male

environmental - drinking non tap
polycyclic aromatic hydrocarbons
nitrosamines

HPV

bisphosphonates

Question 2

what are the signs and symptoms of oesophageal cancer ?

Answer 2

Prominent symptoms usually do not appear until the cancer has infiltrated over 60% of the circumference of the esophageal tube
appears very late in stage:

dysphagia - difficulty swallowing - RED ALERT (60 percent of dysphagia cases due to cancer )
cancer is advanced stage
which is often experienced first with solid foods and later with softer foods and liquids. Pain when swallowing is less unusual at first.

odenophagia - pain when swallowing

vomiting

weight loss

coughing blood

hoarseness of voice

metstastatic :
VIRCHOW NODE 
hepatomegaly 
pleural effusion
chest pain radiating to back - invasion of neuromediastinal involvement

Question 3

diagnosis of esophageal cancer ?

Answer 3

barium swallow x ray

endoscopy and biopsy - forceps and brush
Exophytic, friable, ulcerated
Endophytic, deep infiltration

staging
CT / PET scan
priority given to ENDOSCOPIC US - high specificity for lymph node involvements

Question 4

T staging of esophegal carcinoma

Answer 4

stage 0 carcinoma in situ - limited to the epithelium of the esophagus and does not cross the basement moraine

1 - limited to the laminapropria
1b - limited the submucosa

2 infiltrates muscular propria
2a - into the circular layer of the muscle
2b- into the longitudinal layer of the muscle

stage 3 - adventitia of the esophagus and near by lymph nodes

4a -invaded the pleura , pericardium diaphragm but resectable
b - unresectable - invades structure such as aorta and trachea

Question 5

where does oesophageal cancer metastasis into ?

Answer 5

brain , lungs , liver and bone

Question 6

what is the treatment of oesophageal carcinoma ?

Answer 6

stage Tis and 1a = surgery and EMR endoscopic mucosal resection
or ablation
1b - esophagoectomy if possible or endoscopic submucosal dissection

stage 2 =
preoperative chemoradiotherapy then surgery if it is located not in the neck area (esophagoectomy and lymphectomy) followed by adjuvant therapy -chemoradiotherapy

stage 3 “”

stage 4 - chemoradiotherapy

external beam radiation

esophgeal dilation or
/ esophageal stent placement

Photodynamic laser therapy

Electrocoagulation

bipolar cauterisation of the tumor

Question 7

what are the contraindications for surgery ?

Answer 7

distal metastasis such as left supraclavicular lymph nodes

and extensive lesion - extensive to trachea , lung , mediastinum

Question 8

in the proximal third of the esophagus where’d does the lymphatic drain to ?

Answer 8

deep cervical lymph nodes

Question 9

in the middle third of the esophagus where does the lymphatics drain too ?

Answer 9

superior and posterioir mediastinal nodes

Question 10

in the distal third of esophagus where doe the lymphatics drain to ?

Answer 10

follow the left gastric artery into the gastric and iliac lymph nodes

Question 11

what are the types of oesophageal cancer and which is the most common ?

Answer 11

squamous cell carcinoma -

adenocarcinoma- most common

Question 12

adenocarcinoma is commonly found where in the esophagus ?

Answer 12

distal third of the esophagus

Question 13

where is squamous cell carcinoma usually found in the esophagus

Answer 13

mostly upper and middle part of the esophagus

Question 14

what is the morphology of these oesophageal cancers ?

Answer 14

polypoid - most common
sessile or pedunculate

ulcerating

infiltrating - gradual narrowing
mostly malignant

superficial spreading carcinoma

Question 15

how many histological gradings are there for oesophageal cancer ?

Answer 15

4

Question 16

describe the four histological grading of oesophageal cancer ?

Answer 16

Gx = 
G1 - well diffrentiated 
G2 - moderately differentiated 
g3 - poorly differentiated 
G4 - undifferentiated

Question 17

what is the prophylaxis od squamous cell carcinoma ?

Answer 17

selenium 
b carotene 
a tocopherol 
green tea 
aspirin
zinc 
folate supplementation

Question 18

what is the survival chances for oesophageal carcinoma ?

Answer 18

5 year survival rate :

if not penetrating the submucosa - 60 percent of cases

muscular mucosa involved - 30 percent

adventitia involved - 10 percent

Question 19

why can the oesophageal cancer easily penetrate the adjacent organs ?

Answer 19

esophagus does not have a serosal cover so can penetrate into the trachea , pleura , aorta and diaphragm

Question 20

what are the complication of oesophageal cancer ?

Answer 20

dysphonia - caused by paralysis of n reccurens

claude bernard horner syndrome (miosis pupil shrink and droopy eyelid )
involvement of sympathetic ganglia

esophgeo Trachea bronchial fistula

haemorrhage

aspiration pneumonia - if blockage

Question 21

what is photodynamic therapy in esophgeal cancer ?

Answer 21

photosensitive substances are introduced - hematoporphirin which selectively accumulate in tumor and irradiate through endoscopic laser

Question 22

what are the risk factors specifically for adenocarcinoma of the esophagus ?

Answer 22

diet high in cholesterol , animal protein and vitB12

alcohol

increased BMI

barett esophagus - GERD

Question 23

what are the protective factors for adenocarcinoma ?

Answer 23

fibre
folate
vitamin C , E , B6
aspirin

Question 24

is metastasis common in oesophageal cancer ?

Answer 24

rare

Question 25

what are the risk factors specifically for squamous cell carcinoma ?

Answer 25

ENT conditions past or present 
smoking / alcohol 
achalasia
high temp fluid 
tylosis 
plummer vinson syndrome

Question 26

vocal cord paralysis as a symptom is typical for which type of cancer ?

Answer 26

SCC