Oesophageal Cancer

Question 1

Define oesophageal cancer

Answer 1

Malignant tumour (mucosal lesions) that originate in the epithelial cells lining the oesophagus

Mainly adenocarcinoma (85%) and Squamous cell carcinoma (15%). May also be lymphoma, melanoma, leiomyosarcoma.

Question 2

Aetiology of Squamous cell Carcinoma of the oesophagus

Answer 2

Mainly mid-upper oesophagus (Upper 2/3)

Associated with tobacco use, excessive alcohol consumption and HPV infection

Question 3

Aetiology of adenocarcinoma of the oesophagus

Answer 3

Mainly lower oesophagus (1/3) + junction

GI reflux, Barrett’s, obesity, high fat and cholesterol diet
Fruit and vegetable protective

Question 4

Risk factors for Adenocarcinoma of the oesophagus

Answer 4

Male 
GORD and Barrett's
Hiatus hernia
Obesity 
Drugs

Question 5

Risk factors for SqCC of the oesophagus

Answer 5

Male 
Tobacco
Alcohol
Family history of UGI cancer
Non-white
HPV 
Achalasia

Question 6

What is Plummer-Vinson syndrome

Answer 6

Cause of dysphagia

Microcytic hypochromic anaemia (IDA)
Atrophic glossitis
Oesophageal webs or strictures

Question 7

Presenting symptoms of oesophageal cancer

Answer 7

Dysphagia (solids, then liquids)
Regurgitation
Odynophagia 
Weight loss, fatigue
Hoarseness 
Aspiration
Hiccups  (phrenic nerve involvement)
Post-prandial/paroxysmal cough

Question 8

Signs of oesophageal cancer

Answer 8

May not have signs

Signs of weight loss
mets -> supraclavicular lymphadenopathy, hepatomegaly
Resp signs if tracheal involvement

Question 9

Investigations for oesophageal cancer

Answer 9

1. OGD with biopsy (shows mucosal lesion)

Metabolic profile: hypokalaemia, elevated Cr and U/nitrogen

CT/MRI thorax and abdomen: indicates size of the primary tumour, local invasion, presence of metastases
FDG-PET scan: hyperactivity at primary site and may show metastases
Endoscopic USS: extent of local invasion and presence/absence of spread to the lymph nodes

Bronchoscopy: ?involvement of the tracheobronchial tree