Oeophageal cancer

Question 1

what are the different types of oesophageal cancer

Answer 1

SCC - upper two thirds
adenocarcinoma - lower third

Question 2

risk factors for SCC of the oesophagus

Answer 2

smoking and excessive alcohol consumption

(other risk factors include chronic achalasia, low vitamin A levels and, rarely, iron deficiency)

Question 3

risk factors for adenocarcinoma of the oesophagus

Answer 3

long-standing GORD, obesity, and high fat intake, as occurs from Barrett’s oesophagus

Question 4

presentation of oesophageal cancer

Answer 4

Majority of cases do not present till late due to vague initial symptoms
Dysphagia, typically progressive in nature (solids then liquids).
Patients may also report significant weight loss, due to both dysphagia and cancer-related anorexia.
Other less common symptoms include odynophagia or hoarseness of voice

Question 5

what investigations can you do for oesophageal cancer

Answer 5

ODG + biopsy
CT CAP for staging and mets
Endoscopic ultrasound to measure the penetration into the oesophageal wall
FNA of lymph nodes

Question 6

what management do most people with oesophageal cancer receive

Answer 6

Most patients present with advanced disease so 70% of patients are therefore only treated palliatively

Question 7

what treatment options are there for those with oesophageal SCC

Answer 7

harder to have a curative treatment due to its more proximal location so chemoradiotherapy is the main treatment.

For palliative care an oesophageal stent thickened fluids and nutritional supplements can also be used or a radiologically inserted gastrostomy

Question 8

what are the treatment options for oesophageal adenocarcinoma

Answer 8

neoadjuvant chemoradiotherapy
oesophageal resection: either L/R throacotomy with either laprascopic or neck incision

Question 9

what is an Ivor Lewis procedure

Answer 9

Right thoracotomy with laparotomy (termed an Ivor-Lewis procedure)

Question 10

what are complications which can arise from oesophageal resection

Answer 10

anastomotic leak (8%), re-operation, pneumonia (30%), and death (4%)

Question 11

how are anastomotic leaks generally managed

Answer 11

Anastomotic leaks are managed by laparotomy, washout and repair.
Also requires broad spec ABX and IV fluids.

Smaller leaks may be managed with just IV ABX.

Question 12

what is the nutritional recovery like for patients who have undergone oesophageal resection

Answer 12

start sipping clear fluids at around day 5, then gradually start building up to a soft diet at around day 12.
feeding jejunostomy to aid nutrition.
It’s a very major surgery and can take 6-9 months for full recovery
most patients will need to eat 5-6 small meals per day to meet their nutritional requirements in the long term due to early satiety