FN: Gastrointestinal Surgery Oesophageal Cancer

Question 1

Epi

Answer 1

Incidence:12/100,000 increasing (increasing Barrett’s prevalence)
Age: 50-70 yrs
Sex: M>F = 5:1

Question 2

Risk Factors

Answer 2

EtOH
Smoking
Achalasia
GORd → Barretts
Plummer-Vinson
Fatty diet
Reduced Vit A + C
Nitrosamine exposure

Question 3

Pathophysiology

Answer 3

65% adenocarcinoma
• Lower 3rd
• GORD → Barrett’s → dysplasia → Ca

35% SCC
• Upper and middle 3rds
• Assoc. with EtOH and smoking
• Commonest type worldwide

Question 4

Presentation

Answer 4

Progressive dysphagia: solids → liquids (esp. bread)
→Often alter dietary habit → soft food → exacerbation of wt. loss
• Wt. loss
• Retrosternal chest pain
• Lymphadenopathy
• Upper 3rd:
→ Hoarseness: recurrent laryngeal N. invasion
→ Cough ± aspiration pneumonia

Question 5

Spread

Answer 5

Direct extension, lymphatic’s and blood

75% of pts have mets @ Diagnosis

Question 6

Bloods

Answer 6

FBC: anaemia
LFTs: hepatic mets, abumin

Question 7

Diagnosis

Answer 7

Upper GI endoscopy:aloows biopsy

Ba swallow: not often used, apple-core stricture

Question 8

Staging

Answer 8

TNM:
• CT
• EUS
• Laparoscopy/mediastinoscopy: mets

Question 9

Treatment:

Answer 9

1. Oesophagectomy
2. Palliative
   a. Majority of pts.
   b. Laser coagulation
   c. Alcohol injection + reduced ascites (spiro)
   d. Stening and Secretion reduction (e.g. hycosine patch)
   e. Analgesia e.g. fentanyl patches
   f. Radiotherapy: external or brachytherapy
   g. Referral
   i. Palliative care team
   ii. Macmillian nurses

Question 10

Benign Tumours:

Answer 10

• Leiomyoma
• Lipmoas
• Haemangiomas
• Beningn polyps