Esophageal/gastric Cancer Flashcards
Esophageal Cancer
general
types
♂>♀
↑ risk with age; 6th and 7th decade of life
Types:
Squamous cell carcinoma (SCC)
Most common type worldwide
Blacks/Asians > Whites
Adenocarcinoma
Most common type in the United States
Accounts for 2/3 of esophageal carcinoma cases
Increasing incidence
Whites > Blacks
Metastatic cancer
Constitutes 3% of esophageal cancer
Melanoma and breast cancer are the most likely to metastasize
esophageal cancer
S/Sx
Asymptomatic in the early stage
Dysphagia
Occurs when constriction of the esophageal lumen is < 13 mm
Progressive problem: solid food → semisolid food → liquids and/or saliva
Odynophagia
Weight loss
Present in almost all cases despite good appetite
Chest pain
Pressure or burning pain that radiates to the back
GI bleeding
Vocal cord paralysis and hoarseness
Compression of the recurrent laryngeal nerve
Dyspnea
Malignant pleural effusions or pulmonary metastasis
Squamous Cell Carcinoma of the Esophagus
General
Early vs advanced lesion
Most common malignant tumor in the proximal 2/3 of the esophagus
Early lesion: friable tissue, erythema, and erosions
Advanced lesion: infiltrating or ulcerated mass, may be circumferential
Squamous Cell Carcinoma of the Esophagus
RF
Risk factors:
Alcohol
Tobacco use (in any form)
HPV infection
Adenocarcinoma of the Esophagus
general
Most common malignant tumor in the distal 1/3 of the esophagus
Most often arises from Barrett esophagus – a condition brought on by chronic gastrointestinal reflux disease and reflux esophagitis
Early lesion: mucosal irregularities, ulcer, or nodule
Advanced lesion: ulcerated or exophytic mass with obstruction
Adenocarcinoma of the Esophagus
RF
Tobacco use (in any form)
GERD
Obesity (central fat distribution)
Esophageal cancer
esophageal cancer
Dx
Endoscopy with brush cytology and biopsy
Identified cancer
CT of the chest and abdomen
Determine the extent of tumor spread
Endoscopic ultrasound (EUS) of the esophagus
Determine the depth of the tumor in the esophageal wall and regional lymph node involvement
Basic blood tests: CBC with differential, electrolytes, and liver function
Esophageal cancer
Tx
Treatment depends on tumor staging, size, and location
TNM classification
Staging is 0-IV
Surgical resection, often combined with chemotherapy and radiation
Immunotherapy plus chemotherapy for advanced cancers
Locoregional esophageal cancer staging
Locoregional esophageal cancer staging:
The cancer is seen as the lesion penetrating the esophageal wall
Staging from T1 (mucosa and submucosa) to advanced disease, involving adjacent structures in T4 and the lymph nodes (N)
Esophageal cancer
Prognosis
Depends on the stage of the tumor
Overall survival is poor due to patients presenting with advanced disease
Cancer restricted to the mucosa → 80% survival rate
Cancer with submucosal involvement → < 50% survival rate
Cancer with extension to the muscularis → ~20% survival rate
5-year survival: < 5%
Esophageal cancer
Prevention
Making healthy choices is the best prevention
Gastric metaplasia
general
Precancerous change characterized by histologic change from normal gastric cardia, fundic, and antral mucosa to epithelium that resembles the small intestine
Occurs due to chronic irritation and inflammation of the stomach lining caused by various factors such as gastric acid, bile salts, H. pylori infection, smoking, alcohol, and environmental contaminants
Increased risk of dysplasia → stomach cancer
What would be 1st on your differential?
GERD