Malignancies Of The Oesophagus

Question 1

How long is the oesophagus approximately?

Answer 1

25cm

Question 2

Where does the oesophagus extend to and fro:

Answer 2

C6 to T11

Question 3

Name the 4 clinical subdivisions of the oesophagus:

Answer 3

Cervical region
Upper Thoracic region
Midthoracic region
Lower Thoracic region

Question 4

Where does the cervical oesophagus extend from and to?

Answer 4

From the cricopharynxgeus to the thoracic inlet (T1 vertebrae)

Question 5

Where does the upper oesophagus extend from and to?

Answer 5

From the thoracic inlet to the trachea bifurcation at the inferior level of theT4 vertebrae

Question 6

In an endoscopic evaluation where does one begin to measure the oesophagus?

Answer 6

From the incisors

Question 7

At what length, is the first oesophageal narrowing found?

Answer 7

At 15-17cm

Question 8

At what length, is the second oesophageal narrowing found?

Answer 8

38-40cm

Question 9

At what length is the aortic arch and left main bronchus indentation found on the oesophagus?

Answer 9

25cm

- On the anterolateral surface of the oesophagus

Question 10

Which gender experience a shorter oesophagus?

Answer 10

Females

Question 11

What are the 2 histological types of oesophageal cancers?

Answer 11

• Adenocarcinomas

- Squamous cell carcinoma

Question 12

What type of cells line the entire oesophagus?

Answer 12

• Squamous cells

Question 13

Name 6 factors that increase the risk of developing oesophageal malignancies?

Answer 13

Drinking excessive alcohol 
Smoking 
Deficiencies in essential vitamins I.e. Riboflavin
Barrett’s oesophagus 
High BMI 
GORD

Question 14

Which gender is more likely to develop an oesophageal malignancy?

Answer 14

Men

At a ration for 3-4:1

Question 15

What are presenting signs or symptoms of patients presenting with oesophageal malignancies?

Answer 15

Dysphagia (most common, may start off as solids, but includes liquids)
Weight loss (second most common)
Bleeding 
Epigastric and retrosternal pain 
Persistent cough
Hoarseness 
Bone pain with metastatic pain

Question 16

What physical signs can be seen in a patient presenting with oesophageal metastasis?

Answer 16

Hepatomegaly (From hepatic metastases)
Wasting
Lymphadenopathy (In the latero-cervical and supraclavicular region)

Question 17

Name 3 mechanisms used to diagnose oesophageal metastases:

Answer 17

Barium swallow

Esophogastroduodenoscopy

• Allows direct visualizations
• Takes biopsies

Computed tomography of the abdomen and chest

• Assessing lung and liver metastasis
• Invasion of adjacent structures.

Question 18

Run through the TNM classification of metastases:

Answer 18

• Tis - Carcinoma in situ/high-grade dysplasia
• T1 - Lamina propria or submucosa
• T2 - Muscularis propria
• T3 - Adventitia
• T4 - Adjacent structures
• N0 - No regional lymph node metastasis
• N1 - 1-2 regional lymph nodes (N1 is site dependent)
• N2 - 3-6 regional lymph nodes
• N3 - More than 6 regional lymph nodes
• M0 - No distant metastasis
• M1 - Distant metastasis

Question 19

What is the treatment management for stage I oesophageal cancer?

Answer 19

Consideration for endoscopic therapy 
  - Mucosal resection 
  - Submucosal dissection 
  - Particularly for ‘Tis and T1N0
Consideration for initial surgery  for T1 and any N

Question 20

What is the treatment management for stage II-III oesophageal cancer?

Answer 20

Trimodality therapy

- Consider chemoradiation followed by therapy.

Question 21

What is the treatment management for stage IV oesophageal cancer?

Answer 21

Symptomatic and supportive care.

Question 22

Name the palliative symptoms of oesophageal malignancies?

Answer 22

Dysphagia 
Anxiety
Coughing 
Retrosternal pain
Weight loss 
Bleeding 
Pain of ulceration.