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#passmed 2022 > Oesophageal Cancer > Flashcards

Oesophageal Cancer Flashcards

1
Q

What gender is oesophageal cancer more common in?

A

Males

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2
Q

What are the 2 types of oesophageal cancer?

A
  1. Adenocarcinoma

2. Squamous cell carcinoma (SCC)

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3
Q

Which oesophageal cancer is more common in the developing world?

A

SCC

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4
Q

Which oesophageal cancer is more common in the developed world?

A

Adenocarcinoma

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5
Q

Where does adenocarcinoma usually occur?

A

Lower 1/3 of oesophagus

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6
Q

Where does SCC usually occur?

A

Upper 2/3 of oesophagus

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7
Q

What is adenocarcinoma caused by?

A

Barrett’s oesophagus –> dysplasia –> malignant

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8
Q

What are the risk factors for adenocarcinoma? (3 things)

A
  1. GORD
  2. Obesity
  3. Smoking
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9
Q

What are the risk factors for SCC? (3 things)

A
  1. Smoking
  2. Alcohol
  3. Achalasia
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10
Q

What are the clinical features of oesophageal cancer? (6 things)

A
  1. Dehydration signs
  2. Dysphagia (most common) (problems swallowing)
  3. Odynophagia (pain swallowing)
  4. Hoarseness
  5. Cachexia (muscle wasting)
  6. Weight loss
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11
Q

What are some differentials that present similarly to oesophageal cancer? (5 things)

A
  1. Barrett’s oesophagus
  2. Oesophageal stricture
  3. Oesophageal spasm
  4. Achalasia
  5. Oesophageal ring & web
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12
Q

How should Barrett’s oesophagus be managed?

A

Surveillance to detect dysplasia + adenocarcinoma

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13
Q

How do you DIFFERENTIATE between Oesophageal stricture and Oesophageal Cancer? (2 things)

A
  1. Barium swallow: shows narrowed lumen

2. Upper endoscopy: biopsy (+dilation)

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14
Q

How do you DIFFERENTIATE between Oesophageal spasm and Oesophageal Cancer? (2 things)

A
  1. OS = sudden onset chest pain not exertion related

2. Manometry = shows oesophageal contractions

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15
Q

.How do you DIFFERENTIATE between Achalasia and Oesophageal Cancer?

A

High-res manometry

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16
Q

What is Oesophageal Ring & Web?

A

Thin structures that partially occlude oesophagus

17
Q

How do you DIFFERENTIATE between Oesophageal ring & web and Oesophageal Cancer? (2 things)

A
  1. Barium swallow

2. Upper endoscopy

18
Q

What should you assume about ALL patients with dysphagia?

A

Oesophageal cancer until proven otherwise

19
Q

How should suspected oesophageal cancer be investigated? (2 things)

A
  1. Urgent upper GI endoscopy (OGD) within 2 wks

2. Any malignancy = biopsied –> histology

20
Q

What are further investigations that can be done to determine the staging of the oesophageal cancer? (6 things)

A
  1. CT chest-abdo-pelvis
  2. PET-CT
  3. Endoscopic US
  4. Staging laparoscopy
  5. Fine Needle Aspiration Biopsy (FNA)
  6. Bronschoscopy
21
Q

What are CT chest-abdo-pelvis and PET-CT done for in suspected oesophageal cancer?

A

See distant metastases

22
Q

What is endoscopic US used for in suspected oesophageal cancer? (2 things)

A
  1. Measure penetration into oesophageal wall (T stage)

2. Assess + biopsy sus lymph nodes

23
Q

What is staging laparoscopy used for in oesophageal cancer?

A

To see intraperitoneal metastases

24
Q

What is Fine Needle Aspiration biopsy (FNA) used for in oesophageal cancer?

A

For palpable cervical lymph nodes

25
Q

When should a bronchoscopy be done in oesophageal cancer?

A

@ hoarseness / haemoptysis

26
Q

What percentage of oesophageal cancer management is palliative?

A

70%

27
Q

What is the curative treatment for oesophageal cancer?

A

Surgery +/- chemo / chemoradiotherapy

28
Q

What is the curative treatment for adenocarcinomas?

A

Chemo / chemoradiotherapy then oesophageal resection

29
Q

What is the curative treatment for SCC?

A

Hard to operate on so just chemoradiotherapy

30
Q

What are the local complications of oesophageal cancer? (3 things)

A

Local spread to

  1. Trachea (cough)
  2. Recurrent laryngeal nerve (hoarseness + vocal paralysis)
  3. Tracheoesophageal fistula
31
Q

Where can oesophageal cancer metastasise to? (3 things)

A
  1. Lymph nodes (aortic / liver / lung / mediastinal)
  2. SCC = intra-thoracic
  3. Adenocarcinoma = intra-abd

#passmed 2022 (27 decks)

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