oesophageal cancer

Question 1

what are the 2 types of oesophageal cancer?

Answer 1

• squamous cell carcinoma- most common worldwide and seen more commonly in the top two thirds of the oesophagus
• adenocarcinoma- Adenocarcinoma is now the leading cause of oesophageal carcinoma in the Western world due to increasing rates of metabolic syndrome.
• adenocarcinoma is present in the lower third

Question 2

what are risk factors for oesophageal cancer?

Answer 2

Smoking is the most important risk factor, but others include:

High alcohol intake
Achalasia
pharyngeal pouch 
Oesophageal web
High intake of hot beverages

Question 3

what is the clinical presentation for oesophageal carcinoma?

Answer 3

typically presents with progressive dysphagia from solids to liquids. This differs from motility disorders such as oesophageal spasm and achalasia which tend to have dysphagia to solids and liquids from the start.

Anyone who presents with dysphagia should immediately be referred an upper GI endoscopy to rule out oesophageal carcinoma.
Patients may also have pain on swallowing (odynophagia).

Weight loss is the second most common symptom, due to a combination of anorexia and dysphagia.

Hoarseness can develop if there is local invasion of the recurrent laryngeal nerve.

Question 4

what other things should you ask about in a dysphagia history?

Answer 4

• neurological signs and symptoms
• any recent chest infections- might want to do a CXR to check for any aspiration pneumonia due to swallowing difficulties

Question 5

what is the management of oesophageal carcinoma?

Answer 5

endoscopic mucosal resection

radiofrequency ablation