Esophageal Neoplasms Flashcards
Which type of CA is more common in developed countries?
Adenocarcinoma > Squamous Cell CA
Which type of CA is more common in developing countries?
SCC > AdenoCA
What are the epidemiological components of esophageal CA?
- Most commonly 50-70 yr
- M > F
- African American > Caucasian
- Tobacco use & excessive ETOH account for 90% of total cases of esophageal SCC
Where is SCC commonly located in the esophagus?
middle esophagus, upper 2/3
Where is adenocarcinoma typically located in the esophagus?
distal 1/3 esophagus
What is a major risk factor for SCC?
Smoking and ETOH, poor diet
What is a major risk factor for AdenoCA?
Barrett’s esophagus (30 fold risk), tobacco, obesity
What are the risk factors for all esophageal carcinomas?
- Smoking/chew & Alcohol
- Barrett’s esophagus
- Achalasia
- Corrosive-induced esophageal strictures
A. Lye ingestion - Other head, neck, chest cancers
A. Hx of radiation Txfor other conditions in chest - Poor diet
- Obesity
What is the pathophys of esophageal CA?
- Chronic irritation leads to histologic changes in esophageal tissue:
A. Chronic tobacco, alcohol use, reflux
B. Inflammation 2°to Barrett’s esophagus, stricture or achalasia
What cells does SCC arise from?
Epithelial cells
What cells does adenocarcinoma arise from?
Glandular cells
What are the sxs of esophageal neoplasms?
1. Solid food dysphagia A. >90% progression over weeks-months 2. Weight loss 3. Odynophagia 4. Coughing on swallowing A. Suggests invasion into tracheobronchial tree 5. Chest or back pain A. Suggests mediastinal invasion 6. Hoarseness A. Recurrent laryngeal nerve involvement 7. Supraclavicular or cervical lymphadenopathy A. Indicative of mets
Why is an upper endoscopy used to dx esophageal neoplasms?
Confirms diagnosis
Biopsy for histologic Dx
Why is a CT chest and abd/pelvis/ PET scan performed in esophageal neoplasms?
- Used for staging & helps determine Tx
- Look for lung or liver mets, lymphadenopathy & local tumor extension
A. Predictors for poor prognosis
B. Mediastinal spread & lymph node involvement
What are the lab test results for esophageal neoplasms?
- Lab tests are nonspecific
+/- anemia, ↑ LFT’s if liver mets, ↑ Alk Phos if bone mets
What is Stage 0 (carcinoma in situ)?
Abnormal cells in mucosa
What is stage I esophageal cancer?
Cancer formed & spread to submucosa
What is stage II (A and B) esophageal cancer?
- Stage II A: Involves esophageal muscle
2. Stage II B: Involves any of the first 3 layers of esophagus & nearby lymph nodes
What is stage III esophageal cancer?
- Involves outer esophageal muscle wall & adventitia
2. May involve tissues or lymph nodes near esophagus
What is stage IV (A and B) esophageal cancer?
- Stage IV A: Involves nearby or distant lymph nodes
2. Stage IV B: Involves distant lymph nodes &/or other organs
What does treatment depend on?
- Tumor stage
- Patient preference & functional status
- Expertise of attending surgeons, oncologists, gastroenterologists & radiation oncologists
What are the 2 categories of carcinoma tx?
- Therapy for curable disease
2. Therapy for incurable disease
What is the therapy for a curable carcinoma in stage 0 and I?
- High cure rate
- Surgery (resection) w/ or w/o chemo-radiation Tx
- Chemo + radiation w/o surgery
What is the therapy for a curable carcinoma in stage II A, II B, and III?
- Fit patients
2. Pre-op chemo-radiation Tx , then resection (esophagectomy)
What is the therapy for an incurable carcinoma in stage III and IV?
- Not surgical candidate
- Palliative care
A. Radiation Tx, chemotherapy or both
What are the chemotherapy options for incurable carcinoma in stage III and IV?
- 5-FU + Cisplatin
- Docetaxel (2nd -line)
What are the treatment goals for an incurable carcinoma in stage III and IV?
1. Relieve dysphagia & pain A. Wire stent 2. Optimize quality of life A. Feeding tube placement 3. Minimize treatment side effects
Where is a common metastasis location for esophageal carcinoma?
Local spread to mediastinum is common
What is the prognosis for esophageal carcinoma?
Overall 5-yr survival rate for esophageal cancer is < 20%
