Oesophageal cancer

Question 1

What type of cancer is associated with GORD or Barrett’s

Answer 1

oesophageal ADENOCARCINOMA

Question 2

The majority of adenocarcinomas are located near the ?

Answer 2

gastroesophageal junction whereas squamous cell tumours are most commonly found in the upper two-thirds of the oesophagus

Question 3

Risk factors of squamous cell cancer?

Answer 3

smoking
alcohol
achalasia
plummer-vinson syndrome
diets rich in nitrosamines

Question 4

symptoms of oesophageal cancer?

Answer 4

• dysphagia: the most common presenting symptom
• anorexia and weight loss
• vomiting
• other possible features include:odynophagia, hoarseness, melaena, cough

Question 5

Diagnosis of oesophageal cancer

Answer 5

• Upper GI endoscopy with biopsy is used for diagnosis
• Endoscopic ultrasoundis the preferred method for locoregional staging
• CT scanning of the chest, abdomen and pelvis is used for initial staging
  • FDG-PET CT may be used for detecting occult metastases if metastases
    are not seen on the initial staging CT scans.
  • Laparoscopy is sometimes performed to detect occult peritoneal disease

Question 6

Treatment of oesophageal cancer

Answer 6

• Operable disease is best managed by surgical resection - the most common procedure is an Ivor-Lewis type oesophagectomy
• The biggest surgical challenge is that of anastomotic leak, with an intrathoracic anastomosis resulting in mediastinitis
• In addition to surgical resection many patients will be
  treated with adjuvant chemotherapy