Oesophageal Cancer Flashcards
What gender is oesophageal cancer more common in?
Males
What are the 2 types of oesophageal cancer?
- Adenocarcinoma
2. Squamous cell carcinoma (SCC)
Which oesophageal cancer is more common in the developing world?
SCC
Which oesophageal cancer is more common in the developed world?
Adenocarcinoma
Where does adenocarcinoma usually occur?
Lower 1/3 of oesophagus
Where does SCC usually occur?
Upper 2/3 of oesophagus
What is adenocarcinoma caused by?
Barrett’s oesophagus –> dysplasia –> malignant
What are the risk factors for adenocarcinoma? (3 things)
- GORD
- Obesity
- Smoking
What are the risk factors for SCC? (3 things)
- Smoking
- Alcohol
- Achalasia
What are the clinical features of oesophageal cancer? (6 things)
- Dehydration signs
- Dysphagia (most common) (problems swallowing)
- Odynophagia (pain swallowing)
- Hoarseness
- Cachexia (muscle wasting)
- Weight loss
What are some differentials that present similarly to oesophageal cancer? (5 things)
- Barrett’s oesophagus
- Oesophageal stricture
- Oesophageal spasm
- Achalasia
- Oesophageal ring & web
How should Barrett’s oesophagus be managed?
Surveillance to detect dysplasia + adenocarcinoma
How do you DIFFERENTIATE between Oesophageal stricture and Oesophageal Cancer? (2 things)
- Barium swallow: shows narrowed lumen
2. Upper endoscopy: biopsy (+dilation)
How do you DIFFERENTIATE between Oesophageal spasm and Oesophageal Cancer? (2 things)
- OS = sudden onset chest pain not exertion related
2. Manometry = shows oesophageal contractions
.How do you DIFFERENTIATE between Achalasia and Oesophageal Cancer?
High-res manometry
What is Oesophageal Ring & Web?
Thin structures that partially occlude oesophagus
How do you DIFFERENTIATE between Oesophageal ring & web and Oesophageal Cancer? (2 things)
- Barium swallow
2. Upper endoscopy
What should you assume about ALL patients with dysphagia?
Oesophageal cancer until proven otherwise
How should suspected oesophageal cancer be investigated? (2 things)
- Urgent upper GI endoscopy (OGD) within 2 wks
2. Any malignancy = biopsied –> histology
What are further investigations that can be done to determine the staging of the oesophageal cancer? (6 things)
- CT chest-abdo-pelvis
- PET-CT
- Endoscopic US
- Staging laparoscopy
- Fine Needle Aspiration Biopsy (FNA)
- Bronschoscopy
What are CT chest-abdo-pelvis and PET-CT done for in suspected oesophageal cancer?
See distant metastases
What is endoscopic US used for in suspected oesophageal cancer? (2 things)
- Measure penetration into oesophageal wall (T stage)
2. Assess + biopsy sus lymph nodes
What is staging laparoscopy used for in oesophageal cancer?
To see intraperitoneal metastases
What is Fine Needle Aspiration biopsy (FNA) used for in oesophageal cancer?
For palpable cervical lymph nodes
When should a bronchoscopy be done in oesophageal cancer?
@ hoarseness / haemoptysis
What percentage of oesophageal cancer management is palliative?
70%
What is the curative treatment for oesophageal cancer?
Surgery +/- chemo / chemoradiotherapy
What is the curative treatment for adenocarcinomas?
Chemo / chemoradiotherapy then oesophageal resection
What is the curative treatment for SCC?
Hard to operate on so just chemoradiotherapy
What are the local complications of oesophageal cancer? (3 things)
Local spread to
- Trachea (cough)
- Recurrent laryngeal nerve (hoarseness + vocal paralysis)
- Tracheoesophageal fistula
Where can oesophageal cancer metastasise to? (3 things)
- Lymph nodes (aortic / liver / lung / mediastinal)
- SCC = intra-thoracic
- Adenocarcinoma = intra-abd
