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