Oeoesphageal Cancer

Question 1

What are RF for oesophageal cancer?

Answer 1

1. male sex
2. tobacco use
3. excessive alcohol intake
4. GORD and Barrett’s oesophagus
5. family history of oesophageal, stomach, oral, or pharyngeal cancer
6. low socioeconomic status
7. diet low in fresh fruit and vegetables

Question 2

Where does oesophageal cancer originate?

Answer 2

originating from epithelial lining of the oesophagus

Question 3

What are 2 major types of oesophageal cancer?

Answer 3

1. Squamous: upper 2/3rd (haorsness of voice)

2. Adenocarcinoma: lower 1/3rd

Question 4

What are RF for squamous?

Answer 4

1. Alcohol
2. Smoking
3. Strictures
4. Achlasia
5. Nitrosamines

Question 5

What are RF for adenocarcinoma?

Answer 5

1. GORD
2. Barrett’s
3. Obesity
4. Achalasia

Question 6

What is the defintion for barrett’s oesophagus?

Answer 6

metaplasia of normal stratified squamous epithelium to simple columnar epithelium

Question 7

What are symptoms and RF for baretts?

Answer 7

GORD

Question 8

What investigation is used for Barrett’s?

Answer 8

GOLD STANDARD Upper GI endoscopy with biopsy

Question 9

What is the management for Barrett’s non dysplastic?

Answer 9

1. maximise PPI therapy

2. surveillance every 2 years recommended

Question 10

What is the therapeutic intervention for Baretts?

Answer 10

radiofrequency ablation or endsocpic mucosal resection for nodular growths

Question 11

What are symptoms for oesophageal cancer?

Answer 11

1. Dysphagia
2. Odynophagia
3. Weight loss
4. Hoarseness if recurrent laryngeal pressed (upper)

Question 12

What is the dysphagia like in oesophageal cancer?

Answer 12

first solids then liquids (progressive)

Question 13

What are possible DDx for oesophageal cancer?

Answer 13

1. Benign stricture
2. Achlasia
3. Barrett’s oesophagus

Question 14

What is the 1st line investigation for oesophgeal cancer?

Answer 14

Upper GI endoscopy with BIOPSY

Question 15

What is treatment for oesophageal cancer?

Answer 15

1. Surgery oesophagectomy may be tired with adjunct chemo

2. Chemo better than radiotherapy alone

Question 16

What are possible complications of oesophageal cancer?

Answer 16

1. Post op pneumonia
2. Aspiration pneumonia
3. Post-resection oesophageal reflux
4. Oesophago-aortic fistula
5. Tracheo-oesophageal fistula

Question 17

What is prognosis of oesophageal cancer?

Answer 17

With aggressive therapy: 5-year survival for stage 1 disease approaches 80%; for stage 2 disease, it approaches 60%; for stage 3 disease, it ranges between 30% and 50%

Question 18

How do you treat high grade dysplasia?

Answer 18

endoscopic ablation

Question 19

How do you treat low grade dysplasia?

Answer 19

high dose omeprazole and 6 monthly endoscopic surveillance

Question 20

What surgery is used and when?

Answer 20

1. 2 stage oesophagectomy (lower oesophageal carcinoma)

2. 3 stage for upper oesophageal carcinoma

Question 21

What post op care is done in oesophagectomy?

Answer 21

1. Give feeding jejunostomy

2. Stomach in chest so usually get reflux so regular PPI needed