GI: Oesophageal cancer Flashcards

1
Q

What are the types of cancer that can occur in the oesophagus?

A
  • Squamous cell carcinoma
  • Adenocarcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are risk factors of carcinoma of the oesophagus?

A
  • Diet
  • Alcohol excess
  • Smoking
  • Achalasia
  • Reflux oesophagitis +/- barrett’s
  • Obesity
  • Hot-drinks
  • Plummer-Vinson syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What risk factors is oesophageal SCC most closely associated with?

A
  • Alcohol
  • Smoking
  • Obesity
  • Red meats
  • Achalasia
  • Coeliac
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which risk factors is oesophageal adenocarcinoma most closely assocaited with?

A
  • BArrett’s oesopphagus
  • Smoking
  • Obesity
  • Breast cancer treated with radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does adenocarcinoma of the oesophagus arise from in the oesophagus?

A

Primarily arise in columnar-lined epithelium in the lower oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which sex more commonly gets oesophageal carcinoma?

A

Males - 5:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are symptoms of oesohpageal carcinoma?

A
  • 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What age range does carcinoma of the oesophagus most commonly affect?

A

60-70 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the progression of dysphagia in oesophageal carcinoma?

A

Difficulty swallowing solids -> difficulty swallowing liquids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are signs of oesophageal carcinoma?

A

Quite often none until late disease:

  • Lymphadenopathy
  • Weight loss
  • Anorexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What investigations might you do in someone you suspected had oesophageal carcinoma?

A
  • Bloods - U+Es
  • Oesophagogastroduodenoscopy + Biopsy
  • Staging
    • Endoscopic US +/- FNA
    • CT/MRI Thorax/abdomen
    • PET Scan
    • Bone Scan
    • Consider laparoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What might you see on oesophagogastroduodenoscopy in someone with oesophageal carcinoma?

A
  • Mucosal lesion
  • Histology shows squamous carcinoma or adenocarcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When would you consider doing U+E’s in someone with oesophageal cancer?

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What test is crucial in planning treatment?

A

EUS +/- FNA biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does stage Tis mean?

A

Carcinoma in situ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does the stage T1 mean in oesophageal carcinoma?

A

Invading lamina propria/submucosa

17
Q

What does T2 staging mean in oesophageal carcinoma?

A

Invading the muscularis propria

18
Q

What does stage T3 oesophageal carcinoma mean?

A

Invading the adventitia

19
Q

What does stage T4 oesophageal carcinoma mean?

A

Invasion of adjacent structures

20
Q

How would you manage oesophageal cancer?

A

If surgically fit

  • Consider radical oesophagectomy +/- neoadjuvent chemoradiation

If not surgically fit

  • Chemoradiotherapy
  • Palliation - often the only realistic therapy
21
Q

What is the main aim palliation in oesophageal cancer?

A

Aims to restore swallowing:

  • Endoscopic ablation
  • PEG feed
  • Stenting
  • Chemoradiotherapy
  • Brachytherapy
22
Q

What is the 5 year survival for those presenting with oesophageal cancer?

A

5-9%

23
Q

What is involved in a radical oesophagectomy?

A

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.

24
Q

Metastatic spread in someone with oesophageal cancer is usually to..

A

Bone, brain, lung, liver (BBLL)

25
Q

Alarm symptoms for OGD

A

Age >55

Dysphagia

Vomiting

Weight loss

GI bleeding

Epigastric mass