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

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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
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3
Q

What are clinical features of oeseophageal carcinoma?

A
  • dysphagia → most common presenting symptom
  • anorexia + weight loss
  • vomiting
  • odynophagia, hoarseness, melaena, cough
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4
Q

How is oeseophageal carcinoma diagnosed?

A
  • first-lineupper 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
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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.

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