Esophageal cancer Flashcards
what causes oesophageal for both types of SCC and ACcancer ?
being male
environmental - drinking non tap
polycyclic aromatic hydrocarbons
nitrosamines
HPV
bisphosphonates
what are the signs and symptoms of oesophageal cancer ?
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
diagnosis of esophageal cancer ?
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
T staging of esophegal carcinoma
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
where does oesophageal cancer metastasis into ?
brain , lungs , liver and bone
what is the treatment of oesophageal carcinoma ?
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
what are the contraindications for surgery ?
distal metastasis such as left supraclavicular lymph nodes
and extensive lesion - extensive to trachea , lung , mediastinum
in the proximal third of the esophagus where’d does the lymphatic drain to ?
deep cervical lymph nodes
in the middle third of the esophagus where does the lymphatics drain too ?
superior and posterioir mediastinal nodes
in the distal third of esophagus where doe the lymphatics drain to ?
follow the left gastric artery into the gastric and iliac lymph nodes
what are the types of oesophageal cancer and which is the most common ?
squamous cell carcinoma -
adenocarcinoma- most common
adenocarcinoma is commonly found where in the esophagus ?
distal third of the esophagus
where is squamous cell carcinoma usually found in the esophagus
mostly upper and middle part of the esophagus
what is the morphology of these oesophageal cancers ?
polypoid - most common
sessile or pedunculate
ulcerating
infiltrating - gradual narrowing
mostly malignant
superficial spreading carcinoma
how many histological gradings are there for oesophageal cancer ?
4
describe the four histological grading of oesophageal cancer ?
Gx = G1 - well diffrentiated G2 - moderately differentiated g3 - poorly differentiated G4 - undifferentiated
what is the prophylaxis od squamous cell carcinoma ?
selenium b carotene a tocopherol green tea aspirin zinc folate supplementation
what is the survival chances for oesophageal carcinoma ?
5 year survival rate :
if not penetrating the submucosa - 60 percent of cases
muscular mucosa involved - 30 percent
adventitia involved - 10 percent
why can the oesophageal cancer easily penetrate the adjacent organs ?
esophagus does not have a serosal cover so can penetrate into the trachea , pleura , aorta and diaphragm
what are the complication of oesophageal cancer ?
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
what is photodynamic therapy in esophgeal cancer ?
photosensitive substances are introduced - hematoporphirin which selectively accumulate in tumor and irradiate through endoscopic laser
what are the risk factors specifically for adenocarcinoma of the esophagus ?
diet high in cholesterol , animal protein and vitB12
alcohol
increased BMI
barett esophagus - GERD
what are the protective factors for adenocarcinoma ?
fibre
folate
vitamin C , E , B6
aspirin
is metastasis common in oesophageal cancer ?
rare
what are the risk factors specifically for squamous cell carcinoma ?
ENT conditions past or present smoking / alcohol achalasia high temp fluid tylosis plummer vinson syndrome
vocal cord paralysis as a symptom is typical for which type of cancer ?
SCC
