Oeseophageal Carcinoma Flashcards
1
Q
What is the most common type of oeseophageal cancer?
A
- unti recent times, squamous cell carcinoma was most common
- adenocarcinoma incidence rising rapidly
- adenocarcinoma now most common type
- more likely to develop in pts w/ hx of GORD or Barrett’s
Majority of tumours are in middle third of oeseophagus
2
Q
What are the risk factors for oeseophageal cancer?
A
- smoking
- alcohol
- GORD
- Barrett’s
- achalasia
- Plummer-Vinson syndrome
- squamous cell carcinoma also linked to diets rich in nitrosamine
- rare: coeliac disease, scleroderma
3
Q
What are clinical features of oeseophageal carcinoma?
A
- dysphagia → most common presenting symptom
- anorexia + weight loss
- vomiting
- odynophagia, hoarseness, melaena, cough
4
Q
How is oeseophageal carcinoma diagnosed?
A
- first-line → upper GI endoscopy
- contrast swallow helps classify benign motility disorders but no place for assessing tumours
- staging initially w/ CT CAP; if overt metastatic disease identified then further complex imaging unnecessary
- if CT does not show metastatic disease → local stage may be more accurately assessed by use of endoscopic ultrasound
- staging laparoscopy to detect occult peritoneal disease
- PET CT in those with negative laparoscopy
5
Q
What is the management of oeseophageal cancer?
A
- Operable disease best managed surgically
- Ivor-Lewis type oesophagectomy
- Involves mobilisation of stomach + divison of oesophageal hiatus
- Abdomen closed + right sided thoractomy performed
- Stomach brought into chest + oesophagus mobilised further
- Intrathoracic oesophagogastric anastamosis constructed
- Alternative surgical strategies:
- Transhiatal resection → for distal lesions
- Left thoraco-abdo resection
- Total oesophagectomy (McKeown) + cervical oeseophagogastric anastamosis
- In addition to surgical resection → most given adjuvant chemotherapy
Biggest surgical challenge is anastamotic leak, w/ an intrathoracic anastamosis this will result in mediastinitis. Has high mortality. McKeown technique has an intrinsically lower systemic insult in the event of anastomotic leakage.