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Principles and Procedures > Esophageal Cancer > Flashcards

Esophageal Cancer Flashcards

1
Q

What is the 5 year survival rate for esophageal cancer?

A

20% (whites), 15% (blacks)

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2
Q

African americans are 50% higher risk than whites for esophageal cancer. True or false?

A

True

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3
Q

Esophageal cancer is how many times more prevalent in males?

A

3 times

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4
Q

What is the common age of occurrence for esophageal cancer?

A

55-85 yo

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5
Q

What are contributing factors to the occurrence of esophageal cancer in China, Iran, and South Africa?

A

Diet and Environment

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6
Q

What are contributing factors to the occurrence of esophageal cancer in North America and Western Europe?

A

Excessive tobacco and alcohol use

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7
Q

What are some other contributing factors to esophageal cancer?

A

cleaning product ingestion, low fruit and veggie diets, and drinking hot liquids

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8
Q

What is achalasia?

A

occurs when the lower 2/3 of the esophagus loses peristaltic activity. Esophagus dilates and sphincter constricts

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9
Q

What is the risk of esophageal cancer with having achalasia?

A

5-20%

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10
Q

What is Barrett’s esophagus?

A

squamous epithelium changes to columnar epithelium, typically caused by GE reflux.

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11
Q

What is metaplasia?

A

constant changing of mucosa

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12
Q

What histology is associated with barretts esophagus?

A

Adenocarcinoma

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13
Q

75% of esophageal cancer occurs in what portion of the esophagus?

A

Distal esophagus

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14
Q

What is Plummer Vinson syndrome?

A

Iron deficient anemia causes changes to the esophagus, such as webbing atrophic glottis

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15
Q

What histology is Plummer Vinson syndrome risk for?

A

small cell carcinoma

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16
Q

What is tylosis?

A

an inherited genetic disorder that is characterized as excessive growth of hands and feet

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17
Q

What percentage of individuals experiencing tylosis develop SCC?

A

40%

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18
Q

What are the prognostic factors of esophageal cancer?

A

Tumor size, Weight loss greater than 10%, Poor karnofsky, and pt over 65 yo

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19
Q

Histology or grade has prognostic importance in esophageal cancer. True or False?

A

False

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20
Q

What does an esophageal tumor size greater than 5 cm indicate?

A

Distant mets 75% of the time

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21
Q

How long is the esophagus?

A

25 cm long

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22
Q

Where is the esophagus located within the body?

A

Posterior to trachea and anterior to vertebral bodies

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23
Q

Where does the esophagus penetrate the diaphragm?

A

Esophageal hiatus

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24
Q

What is the measurement from the incisor to the cervical esophagus?

A

18 cm

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25
Q

What is the measurement from the incisor to the upper esophagus?

A

24 cm

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26
Q

What is the measurement from the incisor to the middle esophagus?

A

32 cm

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27
Q

What is the measurement from the incisor to the distal esophagus?

A

40 cm

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28
Q

What body landmarks signify the cervical esophagus?

A

Cricoid process to the thoracic inlet

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29
Q

What body landmarks signify the upper esophagus?

A

Suprasternal notch to the tracheal bifurcation

30
Q

What body landmarks signify the middle esophagus?

A

Carina to proximal to EG junction

31
Q

What body landmarks signify the distal esophagus?

A

mid distal distance to EG junction

32
Q

What is the function of the esophagus? (2 answers)

A

Secret mucous, transport food

33
Q

Movement of food from the laryngopharynx to the esophagus is regulated by what structure?

A

esophageal sphincter

34
Q

What is the involuntary movement of the esophageal called?

A

Peristalsis

35
Q

What LN are included in the Cervical esophagus? (3)

A

Internal jugular, cervical and supraclavicular

36
Q

What LN are included in the upper esophagus? (5)

A

subcarinal, paraesophageal, paratracheal, mediastinal, hilar

37
Q

What LN are included in the lower esophagus? (3)

A

Celiac axis and gastric, nodes of curvature

38
Q

What is the clinical presentation of esophageal cancer?

A

Dysphagia and weight loss

39
Q

What is odynophagia?

A

Painful swallowing

40
Q

What are some symptoms of advanced esophageal cancer?

A

Hematemesis, hemoptysis, Hoarseness

41
Q

Fistulas can occur when the esophagus abnormally separates and fuses to the trachea. True or False?

A

True

42
Q

What are some detection methods of esophageal cancer? (4)

A

CT, CBC, Bronchoscopy, Endoscopic Ultrasound

43
Q

What occurs during an endoscopic ultrasound?

A

A transducer is sent down the esophagus and a signal is sent out to which an ultrasound detects the waves during a scan

44
Q

What is the predominant histology of esophageal cancer?

A

Adenocarcinoma

45
Q

What are top 2 sites of metastasis of esophageal cancer?

A

Liver and Lung

46
Q

What is the survival rate based off of Stage 0 esophageal cancer?

A

greater than 90

47
Q

What is the survival rate based off of Stage 1 esophageal cancer?

A

greater than 70

48
Q

What is the survival rate based off of Stage 2A esophageal cancer?

A

15-30%

49
Q

What is the survival rate based off of Stage 2B esophageal cancer?

A

10-30%

50
Q

What is the survival rate based off of Stage 3 esophageal cancer?

A

less than 10%

51
Q

What is the survival rate based off of Stage 4 esophageal cancer?

A

rare

52
Q

What is the preferred tx method for esophageal cancer?

A

surgery alone but rarely possible

53
Q

What are the two most common tx technique for esophageal cancer?

A

Definitive chemo-radiotherapy, Neoadjuvant preoperative chemoradiotherapy

54
Q

What are the surgical techniques used for esophageal cancer?

A

Subtotal or total esophagectomy

55
Q

What is a gastric pull-up in esophageal surgery?

A

Stomach or left colon placed in thoracic cavity

56
Q

What are the characteristic of esophageal cancer needed for curative resection?

A

limited to esophagus, no nodule involvement and medically fit

57
Q

What are the characteristic of esophageal cancer needed for palliative resection?

A

distant mets, nodule mets, extension outside esophagus

58
Q

What are some complication of esophageal cancer surgery? (5)

A

Anastomatic leak, respiratory failure, pulmonary embolus, myocardial infarct, stricture reflux

59
Q

What is the dose restriction in radiation therapy alone for esophageal cancer?

A

65 Gy

60
Q

What is the dose restriction in chemo-radiation therapy for esophageal cancer?

A

50 Gy

61
Q

What is the set up for esophageal cancer?

A

Supine, arms up, immobilized, chin up, SSD Check

62
Q

What are the characteristics of the RT treatment fields for esophageal cancer?

A

Ports large due to potential of spread, included primary + 3-4 cm below GTV

63
Q

What is the superior border for esophageal cancer tx fields?

A

Sup - thyroid cartilage, inf - carina

64
Q

What nodes are typically included in esophageal tx fields?

A

S’clav, Lower cervical, and Med. nodes

65
Q

What is the standard technique of RT when treating esophageal cancer? Include RT types. (6)

A

AP/PA, 45 off the cord (3DCRT, IMRT, VMAT, PROTONS)

66
Q

What are some side effects of esophageal cancer?

A

Esophagitis, food sticking and dysphagia, ulceration, N/V

67
Q

What is the dose restriction on the esophagus?

A

65 Gy, 50 Gy when with chemo

68
Q

What is the TD 5/5 of the heart?

A

50 Gy

69
Q

What is the TD 5/5 of the spinal cord?

A

45 Gy

70
Q

What is the TD 5/5 of the lung?

A

30 Gy

71
Q

What is the TD 5/5 of the Liver?

A

less than 3%

72
Q

What is the TD 5/5 of the kidney?

A

less than 20 Gy, other must be shielded

Principles and Procedures (27 decks)

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