oesophageal cancer

Question 1

What are the types of oesophageal cancer?

Answer 1

Oesophageal squamous-cell carcinoma (more common)

Oesophageal adenocarcinoma

Question 2

When do symptoms appear in oesophageal cancer?

Answer 2

Prominent symptoms usually do not appear until the cancer has infiltrated over 60% of the circumference of the oesophageal tube

Question 3

What are the symptoms of oesophageal cancer?

Answer 3

1. Dysphagia
2. Weight loss (in squamous cell)
3. Pain behind the sternum
4. Heartburn
5. Husky, raspy, or hoarse-sounding cough
6. Nausea, vomiting, regurgitation

Question 4

What sites doe oesophageal cancer commonly spread to?

Answer 4

Lymph nodes, liver, lungs and bone

Question 5

What are the risk factors for squamous-cell oesophageal carcinoma?

Answer 5

1. Tobacco smoking and chewing
2. Alcohol

Synergistic effect between the two

Question 6

What are the risk factors for oesophageal adenocarcinoma?

Answer 6

1. Male sex
2. GERD
3. Barret’s oesophagus
4. Obesity

Question 7

How is oesophageal cancer diagnosed?

Answer 7

1. FBC, U&E, LFT, glucose, CRP
2. Urgen endoscopy (+ biopsy)
3. CXR for metastases
4. Barium swallowing

Question 8

What are the symptoms of a pancoast tumour?

Answer 8

1. severe pain in the shoulder or the shoulder blade (scapula)
2. pain in the arm and weakness of the hand on the affected side
3. Horner’s syndrome

Question 9

What is anatomical location of the two types of oesophageal cancer?

Answer 9

Adeno: near stomach

Squamous: near throat

Question 10

What cell type do carcinomas originate from?

Answer 10

Epithelium

Question 11

How would you manage oesophageal squamous cell carcinoma?

Answer 11

Offer people with resectable non-metastatic SCC of the oesophagus the choice of:

1. Radical chemoradiotherapy
2. Chemoradiotherapy before surgical resection.

Question 12

How would you manage oesophageal adenocarcinoma?

Answer 12

T1N0 oesophageal cancer:
- Endoscopic mucosal resection

Localised:

• chemotherapy before surgery
• chemoradiotherapy before surgery

Question 13

What is the prognosis for oesophageal cancer?

Answer 13

The overall five-year survival rate is 20-25% for all stages

The survival rate for AC and SCC are the same.

Question 14

A 72 year old man has difficulty swallowing solids. He has cancer of the middle third of the oesophagus and hepatic metastases.

Which is the most appropriate initial management of his dysphagia?

A) Chemotherapy
B) Excision of tumour Exclude
C) Gastrostomy feeding tube
D) Oesophageal stent
E) Radiotherapy

Answer 14

Stent