Oesophageal cancer

Question 1

What is the current 5 year survival for oesophageal cancer?

Answer 1

19%, as manifested at an advanced stage prior to diagnosis.

Question 2

What has been the trend of adenoca and scc oesophageal cancer over time?

Answer 2

Adenoca has increased thought to be related to GORD

SCC has decreased though to be due to less smokers

Question 3

What are the risk factors for oesophageal SCC?

Answer 3

Smoking, EtOH, Male, Geography (central asia, china, middleeast), Human Papilloma Virus.
Asoociated with Plummer-Vinson syndrome and achalasia, tylosis and fanconi anaemia.

Question 4

What are the main symptoms of oesophageal cancer?

Answer 4

Dysphagia 
Reflux type symptoms 
Horse voice (later stage) 
Weight loss (later stage)

Question 5

What characteristics do you report on endoscopy for oesophageal cancer?

Answer 5

Tumour location relative to incisors and GEJ
Length of tumour
Degree of obstruction

Question 6

What is the prague classification?

Answer 6

This is the standard for measuring the length of barrets.
C = the length from proximal cardiac notch
M = the length from the maximal tongue of barrets from the cardiac notch

Question 7

What are the indications for endoscopic mucosal resection for concerning barretts?

Answer 7

Nodular or raised Barrett

Suggestive of superficial invasive cancer

Question 8

Why use EMR if there appears to be concerning Barretts?

Answer 8

Provides larger specimens to determine the depth of invasion.

Question 9

What are the eradication rates using EMR for oesophageal adenocarcinoma?

Answer 9

93.8% at median 5 year follow up (sabiston)

Question 10

What does EMR for oesophageal cancer not address?

Answer 10

Nodal involvement

Question 11

What are the risks of nodal involvement for T1a oesophageal adenocarcinoma?

Answer 11

2-15% (Sabiston)

Question 12

Can EMR be used for T1b oesophageal tumours?

Answer 12

Risk of LN involvement increases with the depth of submucosal involvement. Involvement of superficial 1/3 is SM1 and have relatively low rates of nodal involvement (< 10%). Lesions in the deeper 2/3s (SM2/3) may have nodal involvement in nearly 40% of cases.

Question 13

Which of oesophageal sqaumous cell or adenocarcinoma has an increase risk of nodal involvement.

Answer 13

Squamous cell (45% v 26%)

Question 14

Does EUS help in differentiating between T1a and T1b?

Answer 14

No. Need an experienced endoscopist.

Question 15

What is the MAGIC trial

Answer 15

2006 503 pts, RCT
ECC pre and post surgery v surgery alone

Results
Reduced tumour size and less advanced in chemo group
36% v 23%

Question 16

What is the CROSS trial

Answer 16

2012 366 pts
75% adenocarcinoma and 23% scc
Multimodal therapy
- CRx

Question 17

What are the 3 different types of oesophageal SCC?

Answer 17

Verruca cell carcinoma 
- rare subtype 
Spindle cell carcinoma 
- agressive, squamous and spindle cell on histo path 
Basaloid sqamous cell carcinoma 
- rare variant with poor prognosis

Question 18

What is the difference between T1a and T1b oesophageal adenoca?

Answer 18

T1a - invade just lamina propria or muscularis mucosa

T1b - invade into submucosa