GI: Oesophageal cancer Flashcards
What are the types of cancer that can occur in the oesophagus?
- Squamous cell carcinoma
- Adenocarcinoma
What are risk factors of carcinoma of the oesophagus?
- Diet
- Alcohol excess
- Smoking
- Achalasia
- Reflux oesophagitis +/- barrett’s
- Obesity
- Hot-drinks
- Plummer-Vinson syndrome
What risk factors is oesophageal SCC most closely associated with?
- Alcohol
- Smoking
- Obesity
- Red meats
- Achalasia
- Coeliac
Which risk factors is oesophageal adenocarcinoma most closely assocaited with?
- BArrett’s oesopphagus
- Smoking
- Obesity
- Breast cancer treated with radiotherapy
Where does adenocarcinoma of the oesophagus arise from in the oesophagus?
Primarily arise in columnar-lined epithelium in the lower oesophagus
Which sex more commonly gets oesophageal carcinoma?
Males - 5:1
What are symptoms of oesohpageal carcinoma?
-
Dysphagia/Regurgitation
- Intially for solids and then liquids
- Weight loss
- Retrosternal chest pain
-
Hoarseness
- Possible invasion of recurrent laryngeal nerve
- Cough
Tumours often very advanced at time of diagnosis - dysphagia only occurs after 2/3rds of the lumen is diagnosed
Hiccups could indicated phrenic nerve involvement
What age range does carcinoma of the oesophagus most commonly affect?
60-70 years
What is the progression of dysphagia in oesophageal carcinoma?
Difficulty swallowing solids -> difficulty swallowing liquids
What are signs of oesophageal carcinoma?
Quite often none until late disease:
- Lymphadenopathy
- Weight loss
- Anorexia
What investigations might you do in someone you suspected had oesophageal carcinoma?
- Bloods - U+Es
- Oesophagogastroduodenoscopy + Biopsy
-
Staging
- Endoscopic US +/- FNA
- CT/MRI Thorax/abdomen
- PET Scan
- Bone Scan
- Consider laparoscopy
What might you see on oesophagogastroduodenoscopy in someone with oesophageal carcinoma?
- Mucosal lesion
- Histology shows squamous carcinoma or adenocarcinoma
When would you consider doing U+E’s in someone with oesophageal cancer?
Should be performed in advanced cases with near or complete oesophageal obstruction, as patients may become severely volume-depleted and hypokalaemic because of their inability to swallow fluids and their own potassium-rich saliva.
Result
- Hypokalaemia
- Elevated creatinine + serum urea/nitrogen
What test is crucial in planning treatment?
EUS +/- FNA biopsy
What does stage Tis mean?
Carcinoma in situ
What does the stage T1 mean in oesophageal carcinoma?
Invading lamina propria/submucosa
What does T2 staging mean in oesophageal carcinoma?
Invading the muscularis propria
What does stage T3 oesophageal carcinoma mean?
Invading the adventitia
What does stage T4 oesophageal carcinoma mean?
Invasion of adjacent structures
How would you manage oesophageal cancer?
If surgically fit
- Consider radical oesophagectomy +/- neoadjuvent chemoradiation
If not surgically fit
- Chemoradiotherapy
- Palliation - often the only realistic therapy
What is the main aim palliation in oesophageal cancer?
Aims to restore swallowing:
- Endoscopic ablation
- PEG feed
- Stenting
- Chemoradiotherapy
- Brachytherapy
What is the 5 year survival for those presenting with oesophageal cancer?
5-9%
What is involved in a radical oesophagectomy?
The stomach is transplanted into the neck and the stomach takes the place originally occupied by the oesophagus. In some cases, the removed oesophagus is replaced by another hollow structure, such as the patient’s colon.
Metastatic spread in someone with oesophageal cancer is usually to..
Bone, brain, lung, liver (BBLL)
Alarm symptoms for OGD
Age >55
Dysphagia
Vomiting
Weight loss
GI bleeding
Epigastric mass
