oesophageal cancer Flashcards
where is the location of adenocarcinoma of the oesophagus?
lower 3rd of the oesophagus near gastrooesophageal junction
what is the location of oesophageal squamous cell carcinoma?
upper 2/3rds of oesophagus
what are the risk factors for oesophageal adenocarcinoma?
Barrett’s oesophagus: metaplasia from squamous epithelium to mucus-secreting columnar epithelium secondary to GORD
Obesity
Smoking
Rare causes: coeliac disease and scleroderma
what are the risk factors for oesophageal squamous cell carcinoma?
Smoking: more associated with SCC Alcohol Achalasia Plummer-Vinson syndrome Hot beverages Nitrosamines (dietary)
which type of oesophageal cancer is most common|?
adenocarcinoma is the commonest type in the Western world, whilst SCC is more common in countries such as Japan
when is the peak incidence for oesophageal cancer?
80yrs–> most common in males
what are the symptoms of oesophageal cancer?
- progressive dysphagia to solids and liquids
- odynophagia
- weight loss and anorexia
- hoarseness with recurrent laryngeal involvement
- vomiting
what might you find on examination of someone with oesophageal cancer?
- lymphadenopathy
- melena on PR
what is the criteria for a 2WW referral for OGD with suspected oesophageal cancer?
NICE recommends referring patients for an urgent 2-week upper GI endoscopy if they have:
Dysphagia
or ≥ 55 years with weight loss and one of: Epigastric pain Reflux Dyspepsia
what is the primary investigation you need to do when suspecting oesophageal cancer?
Upper GI endoscopy (OGD) and biopsy: first-line investigation and allows for visualisation of masses and biopsy
what imaging would you do later to stage an oesophageal cancer?
- CT chest abdo pelvis (CAP)
- PET CT
- staging laparoscopy
what is the management of adenocarcinoma oesophageal cancer?
localised:
- endoscopic mucosal resection (very early lesions or Barrets)
advanced:
- oesophagectomy- stomach is pulled upwards and acts as an oesophagus
chemo is offered to all surgical patients pre (neoadjuvant) and post (adjuvant) therapy
what is the management for a localised SCC oesophageal cancer?
unlike adenocarcinoma can be cured with chemoradiotherapy, but surgical resection can be offered
how can advanced metastatic oesophageal cancer be managed?
Palliation: stenting for dysphagia
Chemotherapy or chemoradiotherapy: platinum-based agents
Trastuzumab (Herceptin): for HER2 positive metastatic oesophageal cancer, in combination with chemotherapy
what are complications of oesophageal cancer?
Aspiration pneumonia: oesophageal obstruction may result in aspiration
Tracheo-oesophageal or broncho-oesophageal fistula: most likely to occur if the cancer is located in the mid-oesophagus
Metastasis: lymph nodes, liver, lung, bones
what are oesophagectomy related complications?
- anastomotic leak-> which can lead to mediastinitis
- recurrent laryngeal nerve injury
- delayed gastric emptying
what is Barretts oesophagus?
Barrett’s oesophagus describes metaplasia (transformation of one differentiated cell type to another differentiated cell type) of the lower oesophageal lining
from stratified squamous epithelium to mucous secreting columnar epithelium with goblet cells. It occurs in response to acidic stress
what are the risk factors for Barretts oesophagus?
Gastro-oesophageal reflux disease: the single greatest risk factor for developing Barrett’s oesophagus
Middle-age: the average age of diagnosis is approximately 55 years old [6]
Male: 7 times more common in males
Caucasian
Smoking
Obesity
what are GORD symptoms?
- burning epigastric retrosternal pain
- worse when lying flat
- worse with spicy meals
- can wake patient up from sleep
- regurgitation-> leading to sour taste in mouth
- reflux induced cough
how is barrettes oesophagus diagnosed?
- upper GI endoscopy and biopsy
- biopsies follow Seattle protocol- leads to increase in detection of early lesions
what type of surveillance do you do for patients with non dysplastic barrettes oesophagus?
repeat surveillance endoscopy every 3- 5 years
what are the principles of managing a Barretts oesophagus?
- treat underlying reflux= weight loss, smoking cessation, alcohol abstinence, PPI
- endoscopic surveillance- every 3-5 years for non dysplastic and every 6 months for mild dysplasia
- management with endoscopic radio frequency ablation and endoscopic mucosal resection.. do this straight away for a high grade dysplasia
how do you decide if barrettes oesophagus is treated with endoscopic mucosal resection or radio frequency ablation?
Radiofrequency ablation: typically for flat lesions
Endoscopic mucosal resection: typically for raised lesions
