Esophagus Flashcards
1
Q
What is the esophagus?
A
The esophagus is a hollow, muscular tube that connects the throat to the stomach.
2
Q
Where is the esophagus located?
A
It lies behind the trachea and in front of the spine.
3
Q
At what level does the esophagus begin?
A
The esophagus begins at the level of C6.
4
Q
Where does the esophagus terminate?
A
It terminates in the abdomen at the esophageal gastric junction at about T10-T11.
5
Q
How many regions is the esophagus divided into?
A
The esophagus is divided into 3 regions.
6
Q
What are the regions of the esophagus?
A
Upper thoracic, Middle thoracic, Lower thoracic.
7
Q
What is the upper thoracic region of the esophagus?
A
Extends from the cricoid cartilage to the thoracic inlet.
Also known as cervical thoracic.
8
Q
What is the middle thoracic region of the esophagus?
A
Begins at the carina and extends proximally to the esophageal gastric junction.
9
Q
Where can esophageal cancer begin?
A
Esophageal cancer can begin anywhere along the esophagus.
10
Q
How does esophageal cancer grow?
A
It starts in the inner layer of the esophagus wall and grows outward through the other layers.
11
Q
What are the layers of the esophagus wall?
A
Mucosa, Submucosa, Muscularis propria, Adventitia.
12
Q
What is unique about the adventitia layer of the esophagus?
A
It lacks an outer coating or serosal layers.
13
Q
What percentage of all cancers diagnosed in the US is esophageal cancer?
A
Esophageal cancer makes up about 1% of all cancers diagnosed in the US.
14
Q
What is the male to female ratio for esophageal cancer?
A
Esophageal cancer is more common in males with a ratio of 3-4:1 to women.
15
Q
Which demographic is most commonly affected by esophageal cancer in the US?
A
Esophageal cancer is most common in Caucasians.
16
Q
What is the most common type of esophageal cancer among Caucasians?
A
Adenocarcinoma is the most common type among Caucasians.
17
Q
What type of esophageal cancer is more common in African Americans?
A
Squamous cell carcinoma is more common in African Americans.
18
Q
What age group is most commonly diagnosed with esophageal cancer?
A
Esophageal cancer is most common in ages 55-85 years old.
19
Q
At what stage is esophageal cancer usually diagnosed?
A
Esophageal cancer is usually diagnosed at advanced stages and is nearly a uniformly fatal disease.
20
Q
What are the major etiologic factors for squamous cell cancer of the esophagus?
A
Cigarette and alcohol abuse are the most common and important etiologic factors.
21
Q
What dietary factors are linked to esophageal cancer?
A
Heavily seasoned foods and high nitrated foods are linked to esophageal cancer.
22
Q
What diet is considered preventative against esophageal cancer?
A
A diet high in fruits and vegetables is considered a preventative measure against esophageal cancer.
23
Q
What condition has been linked to the development of adenocarcinomas?
A
Obesity has been linked to the development of adenocarcinomas.
24
Q
Which countries have a higher incidence of esophageal cancer?
A
China, Iran, and South Africa have a higher incidence of esophageal cancer.
25
What type of cancer occurs in patients with a history of Barrett Esophagus?
Adenocarcinoma of the esophagus.
26
What is Barrett Esophagus?
A condition in which the distal esophagus is lined with a columnar epithelium rather than a stratified squamous epithelium.
27
What usually causes the mucosal change in Barrett Esophagus?
Gastroesophageal reflux (GERD).
28
What is achalasia?
A disorder in which the lower 2/3 of the esophagus loses its normal peristaltic activity.
29
What happens to the esophagus in achalasia?
The esophagus becomes dilated (termed megaesophagus) and the esophagogastric junction sphincter fails to relax, prohibiting the passage of food into the stomach.
30
What are the clinical symptoms of achalasia?
Progressive dysphagia and regurgitation of ingested food.
31
What is the percentage chance of developing squamous cell carcinoma in patients with achalasia?
Patients have a 5%-20% risk of developing squamous cell carcinomas of the esophagus.
32
What is Plummer-Vinson Syndrome?
Iron deficient anemia characterized by esophageal webs and atrophic glossitis.
33
What is Tylosis?
A rare inherited disorder that causes excessive skin growth on the palms of the hands and soles of the feet.
34
What mutation is associated with Tylosis?
A mutation on chromosome 17 is thought to cause tylosis and the associated squamous cell carcinoma.
35
What is the risk of developing squamous cell carcinoma in individuals with Tylosis?
Individuals with this condition are at a significant risk (about 40%) of developing squamous cell carcinoma of the esophagus.
36
What are early symptoms of esophageal conditions?
Dysphagia (90% of patients)
Odynophagia
Weight loss of more than 10% of body weight in less than 6 months
37
What percentage of patients report odynophagia?
Reported in 50% of patients.
38
What symptoms may patients report prior to diagnosis?
Food sticking in their throat or chest and difficulty swallowing for 3-6 months prior to diagnosis.
39
What may patients experience as a result of eating?
Regurgitation of undigested food and may have aspiration pneumonia.
40
What stage do most esophageal cancers reach before causing symptoms?
Most esophageal cancers do not cause symptoms until they have reached an advanced stage.
41
What is hematemesis?
Hematemeisis is vomiting blood.
42
What causes chronic cough in esophageal cancer?
Chronic cough is caused by a tracheoesophageal fistula.
43
What symptom may occur after eating in esophageal cancer?
Choking after eating.
44
What is hemoptysis?
Hemoptysis is coughing up blood.
45
What syndrome is associated with esophageal cancer?
Horner syndrome.
46
What causes hoarseness in esophageal cancer?
Hoarseness occurs when there is nerve involvement.
47
What is dysphonia?
Dysphonia is abnormal speech or voice.
48
How does esophageal cancer spread locally?
It spreads to adjacent structures in the mediastinum, including the trachea, main bronchus, pleura, and lung (especially the left lung).
49
Why do lesions in the esophagus become large before causing obstructive symptoms?
Because the esophagus is distensible.
50
What is the growth pattern for esophageal cancer?
Growth is usually longitudinal.
51
What is common in the early spread of esophageal cancer?
Early spread to draining lymphatics is common.
52
How does the cervical esophagus drain?
The cervical esophagus drains into the internal jugular, cervical, paraesophageal, and supraclavicular lymph nodes.
53
How does the lower thoracic esophagus drain?
The lower thoracic esophagus drains to the lower mediastinal, left gastric nodes, celiac nodes (most common), and nodes of the lesser curvature of the stomach.
***celiac most common***
54
What percentage of tumors include lymphatic spread?
50% of tumors include lymphatic spread with mid and distal tumors.
55
What are common sites for distant metastasis?
Common sites for distant metastasis include the lung, liver, bones, adrenal glands, and brain.
56
What percentage of patients present with distant metastasis?
50% of patients present with distant metastasis.
57
What imaging tests are used in the diagnosis?
Chest X-ray, Barium swallow (esophogram), CT of upper thorax and abdomen.
58
What does a Barium swallow (esophogram) show?
Can show narrowing at tumor or near obstruction.
59
What diagnostic procedures are used for lesions in the upper and middle third?
Bronchoscopy for upper and middle third lesions, Esophagoscopy/endoscopy.
60
What additional diagnostic tests are performed?
Bone Scan, Liver function test, PET scan.
61
What does a PET scan demonstrate?
Demonstrates involvement of lymph nodes and liver, as well as the primary tumor.
62
Where is squamous cell carcinoma most commonly found?
Most frequently found in the upper and middle thoracic esophagus.
63
What type of esophageal cancer arises from glandular cells?
Adenocarcinomas arise from the glandular cells present in the lower third of the esophagus.
## Footnote
Most common type in the US.
64
Where do adenocarcinomas typically occur?
Typically occurs in the distal esophagus and GE junction.
## Footnote
In the US, the most common site of occurrence is in the lower 1/3 of the esophagus and GE junction.
65
What stage do most patients have at diagnosis?
Most patients have locally advanced or metastatic disease at the time of diagnosis.
66
What kind of treatment is needed in esophageal cancer?
Patients need multimodality treatment.
67
What are the two most commonly used combined modality techniques?
The two most commonly used techniques are definitive chemoradiation therapy and neoadjuvant chemoradiotherapy followed by surgery.
68
What percentage of patients are surgical candidates?
Only 40-60% of patients are surgical candidates.
69
What is the standard treatment of choice?
Neoadjuvant chemoradiation followed by curative surgery remains the standard treatment of choice.
70
What is the current nonsurgical treatment of choice?
Radiation therapy with chemotherapy is considered the current nonsurgical treatment of choice for esophageal cancers.
71
When might radiation therapy alone be used?
Radiation therapy alone might be used in patients who are medically unable to undergo combined modality treatment.
72
Where is surgical resection limited?
In many centers, surgical resection is limited to the middle and lower thirds of the esophagus.
73
How is the cervical esophagus managed?
The cervical esophagus is often managed with radiation therapy and chemotherapy.
74
What does curative surgery usually involve?
Curative surgery usually involves a subtotal or total esophagectomy.
75
What happens during a total esophagectomy?
Typically, the entire esophagus is removed, and continuity of the GI system is maintained by placing either the stomach or left colon in the thoracic cavity.
76
What is done for an obstruction?
For an obstruction, the patient will receive parenteral nutrition.
77
What are the two types of chemotherapy mentioned?
Palliation and neoadjuvant
78
What is chemoradiotherapy?
A combination of chemotherapy and radiation therapy.
79
What are some chemotherapy drug combinations mentioned?
Carboplatin and paclitaxel (Taxol), Oxaliplatin with either 5-FU or capecitabine, Cisplatin with either 5-FU or capecitabine, Cisplatin and Irinotecan (camptosar), Paclitaxel (Taxol) with either 5-FU or capecitabine.
***5 FU***
80
How are chemotherapy drugs typically administered?
Via IV either as an injection over a few minutes or as an infusion over a longer period of time.
81
What is the typical length of chemotherapy cycles?
Most often 2 or 3 weeks long.
82
How long is adjuvant or neoadjuvant chemotherapy typically given?
For a total of 3 to 6 months, depending on the chemotherapy drugs used.
83
What is the standard position for radiation therapy simulation?
Supine position with the patient's arms above their head.
84
How should patients be positioned if their arms are by their sides?
Elbows bent slightly out from the body to place marks on the thoracic cage for 3-point setup.
85
What may need to be adjusted based on 4D CT data?
Margins for clinical treatment volumes.
86
What are the types of Radiation Therapy Beam Arrangements?
3D Fields, AP/PA, Obliques, AP/PA plus obliques, AP and posterior obliques, IMRT fields and VMAT.
87
What factors influence the choice of Radiation Therapy technique?
The technique chosen is dependent on the location of the cancer, proximal vs distal, and which technique minimized the dose to the OARs.
88
What is the palliative dose range for Radiation Therapy?
30-50 Gy.
89
What is the recommended Radiation Therapy dose for nonsurgical patients?
Radiation alone: 60 to 65 Gy; Definitive chemoradiation: 50 Gy.
90
What are OARs of the esophagus?
Lung, Heart, Spinal cord, Kidneys, Liver.
91
What are the side effects of radiation treatment?
Side effects can be acute or chronic and include esophagitis, stenosis, radiation pneumonitis, carditis, spinal cord injury, weight loss, and fatigue.
92
When does esophagitis typically occur during radiation treatment?
Esophagitis occurs about 2 weeks into radiation treatment.
93
What dietary changes may be necessary for patients with esophagitis?
Patients may need a diet of bland, soft, or pureed foods.
94
What dietary recommendations are given for patients experiencing radiation pneumonitis?
Patients should eat small, frequent meals that are high in calories and protein.
95
What alternatives can be used for high-calorie snacks?
High-calorie liquid supplements are good alternatives for high-calorie snacks.
96
What might a physician suggest to ease the pain of swallowing?
The physician may suggest liquid analgesics or viscous lidocaine before meals.
97
What can severe esophagitis necessitate?
Severe esophagitis may necessitate the placement of an NG Tube.
98
What is an important prognostic tool for tumors?
Tumor size is an important prognostic tool.
99
What factors indicate a poor prognosis?
Weight loss of 10%, a poor performance status, and being older than 65 years.
100
What is the overall 5-year survival rate for esophageal cancer?
The overall 5-year survival rate is 23%.
101
What is the 5-year relative survival rate for localized cancer?
The 5-year relative survival rate for localized cancer is 47%.
102
What is the 5-year relative survival rate for regional cancer?
The 5-year relative survival rate for regional cancer is 25%.
103
What is the 5-year relative survival rate for distant cancer?
The 5-year relative survival rate for distant cancer is 5%.
104
What is the combined 5-year relative survival rate for all SEER stages?
The combined 5-year relative survival rate for all SEER stages is 20%.
105
What type of cancer arises from the squamous mucosa?
Squamous Cell Carcinoma arises from the squamous mucosa.
106
What type of cancer is glandular in nature?
Adenocarcinoma is glandular cancer.
107
What is the most common type of esophageal cancer worldwide?
Squamous Cell Carcinoma is the most common type worldwide.
108
What is the most common type of esophageal cancer in the USA?
Adenocarcinoma is the most common type in the USA.
109
Which gender is more commonly affected by esophageal cancer?
Esophageal cancer is more common in males.
110
Which ethnic group has a higher incidence of adenocarcinoma?
Adenocarcinoma is more common in Caucasians.
111
What is the most common type of esophageal cancer in the US?
Adenocarcinoma
