GI - Oesophageal Cancer

Question 1

Epidemiology of oesophageal cancer

Answer 1

• Middle aged men (50-70 ya)
• Male> female
• higher incidence with Barrett’s oesophagus

Question 2

Risk factors for oesophageal cancer

Answer 2

• Alcohol
• Smoking
• Achalasia
• GORD (Barrett’s)
• Plummer-Vinson
• Fatty diet

Question 3

What is the pathophysiology of oesophageal cancer?

Answer 3

• 65% adenocarcinomas (GORD, obesity, fatty diet): lower 1/3
• 35% SCC: upper and middle 1/3, associated with ethanol and smoking

Question 4

Oesophageal cancer: presentation

Answer 4

• Progressive dysphagia of solids, progressive to Lisa users
• Often altered dietary habits with soft foods and wt loss
• Retrosternal chest pain
• lymphadenopathy
• Upper 1/3: hoarseness: recurrent laryngeal N invasion + cough +/- aspiration pneumonia

Question 5

Oesophageal cancer: Ix - bloods

Answer 5

• FBC: Anaemia

- LFTs: hepatic mets, low albumin

Question 6

Oesophageal cancer: Dx methods

Answer 6

• Upper GI endoscopy with biopsy
• Ba swallow: not often used but could show apple core stricture
• Staging (TNM): CT

Question 7

Outline the TNM structure for oesophageal cancer

Answer 7

• Tis: carcinoma in situ
• T1: submucosa
• T2: muscularis propria (circ/long)
• T3: adventicia
• T4: adjacent structures
• N1: regional nodes
• M1: distant mets

Question 8

Treatment: surgical and palliative

Answer 8

• Surgical: only 25-30% have resectable tumours - may have some new-adjuvant chemo before surgery. Prognosis is stage dependent but 15% 5year survival
• Palliative: majority of pts - stenting, laser coagulation, analgesia, radiotherapy + referral to Macmillan/palliative care team.

Question 9

What are some benign tumours of oesophagus

Answer 9

• Leiomyoma
• Lipomas
• Haemangiomas
• Benign polyps