Oephsophagus Flashcards
NZ stats 2013
300 registrations
250 deaths
6th leading cause of cancer death world wide
What are the 2 major subtypes of oesophageal cancer?
Squamous Cell Carcinoma (SCC) and Adenocarcinoma (AC)
Is there a discrepancy between the sexes and Maori and Non-Maori?
Twice as common in men as women.
Maori incidence and mortality rates are higher than non-Maori
SCC epidemiology
- SCC account for about 90% of oesophageal cancers
- Incidence and mortality rates have significantly decreased
- SCC prevalent in E Africa, C Asia, N Iran, N China
- SCC biologically similar for H&N cancers
- Decline possibly due to changes and education: diet, tobacco and alcohol
AC epidemiology
- AC incidence rates have significantly increased in the West (Americas, Australia, Europe)
- Linked to obesity
- Often occur in the lower part of the oesophagus and the GOJ
- AC more chomosomally unstable - harder to treat
What are the risk factors associated with oesophageal cancer?
Lifestyle:
- smoking and alcohol (SCC)
- obesity (AC)
- though both do apply to both
Dietary:
- Red meats and processed foods
- Hot drinks?
Genetics:
- Male and over the age of 45yrs
- Achalasia (valve at GOJ doesn’t work properly (AC)
- Tylosis (inherited condition - thicker skin on palms of hands and feet) (SCC)
Gastro-oesophageal reflux disease (GORD)
- reflux, heart burn (SCC)
Barrett’s Oesophagus
- Cells lining oesophagus are becoming abnormal. (Acid reflux doesn’t help) (AC)
Environmental:
- Previous RT exposure to mediastinum
What is GORD?
Gastro-oesophageal reflux disease
What is Barrett’s Oesophagus?
Cells lining oesophagus are becoming abnormal
What is Achalasia?
valve at GOJ doesn’t work properly
What is Tylosis?
inherited condition - thicker skin on palms of hands and feet
Where is SCC more likely to occur?
Upper 2 thirds of the oesophagus
Where is AC more likely to occur?
Lower third and at the GOJ
What is staging related to?
Related to the destruction of the mucosal layers
What physiological characteristics of the oesophagus lend themselves toward spread of disease?
- Adventitia is easy to invade - lack of serosa layer to act as barrier
- It’s smooth and easy to travel along
- Got good lymphatic drainage
Where does local extension occur?
Pericardium
Trachea
Vertebral bodies
Where does regional lymph node metastasis occur?
Depends where the lesion is.
Cervical: supraclavicular and cervical nodes
Thoracic: Mediastinal nodes - paratracheal and subcarinal nodes
Lower: Left gastric and coeliac nodes
Where is it most likely to metastasise to? and which type is more likely to metastasise?
AC is more likely to develop distant mets
Lung, Liver, Bone
What are the signs and symptoms of oesophageal cancer?
Common:
- Dysphagia (difficulty)
- Odynophasia (pain)
- Weight loss
Other symptoms related to location and spread:
- Hoarseness
- Cough
- Nausea and vomiting
- Regurgitation/reflux due to pressure in the gastric area
- Coughing up blood
- Fatigue
What are the common investigations for oesophageal cancer?
Complete history and physical exam (includes palpation) EUS (Endoscopic Ultrasonography) +/- biopsy/FNA Barium swallow Bronchoscopy Blood tests LFT and PFT CT - abdo, thorax + contrast (LN) PET-CT Bone scan
What is the common RT prescription used for definitive Chemo RT?
45-50.4Gy in 25-28#, 1.8Gy/#
What chemotherapy agents are used for definitive Chemo RT?
5FU and Cisplatin
What is the palliative prescription for oesophageal cancer?
40Gy in 15# - high dose palliative (might just use a POP)
