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3rd Year Semester 1 > oesophageal cancer > Flashcards

oesophageal cancer Flashcards

1
Q

types of oesophageal cancer include:

A

-adenocarcinoma = begins in mucous secreting gland cells
-Squamous cell carcinoma= begins in thin cells of the mucosa that line the inside

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2
Q

where does it occur?
-adeno
-SCC

A

-distal oesogohagus
-upper and middle

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3
Q

Aetiology of SCC

A

black male
smoking (5x risk than non smokers)
alcohol abuse
diet and nutrition
hereditary (tylosis)

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4
Q

Aetiology - adenocarcinoma

A

white male
gastroesophageal reflux disease (GORD)
obesity
smoking
diet and nutrition
hereditary

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5
Q

Clinical Presentation

A

EARLY STAGE GENEREALLY ASYMPTOMATIC
dysphagia(swallowing difficulties)
weightloss
frequent choking while eating
indigestion
coughing/ hoarseness
chest pain

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6
Q

Diagnostic Workup: Ba Swallow

A

-used widely before endoscopy was available
-distinguish gastroesopageal tumours from gastric tumour

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7
Q

Diagnostic Workup: Endoscopy
used for
function

A

-diagnosis, staging, treatment and surveillance
-visualization of circumferential involvement, length and location relative to Gastro oesophageal junction (GOJ) and extent into cardia

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8
Q

The cancer may appear as a:

A

-stricture
-mass
-raised nodule
-ulceration
-irregularity of mucosa

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9
Q

Diagnostic Workup: Biopsy
-when taken
-how
-if biospy is difficult to obtain

A

-taken at time of endoscopy
-recommended 6-8 sample taken from margin around and centre of lesion
-brush cytology can assist

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10
Q

Staging Workup: Endoscopic Resection

A

-vital for accurate staging of early stage tumours
-used for tx of T1a disease
-for small tumours its provides more accurate depth of invasion info than EUS

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11
Q

Staging Workup: EUS
function
limitations

A

«improves clinical staging:
-Locoregionally
-depth of tumour invasion
-nodal status
«
-invasiveness
-reproducibility
-inability to assess distant mets
-high false positive rate 10%

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12
Q

Staging Workup: CT AND PET

A

-used for staging N and M status
-if nodes are greater than 1cm , treated with sus
-high resolution in CT useful in detecting pulmonary mets

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13
Q

Staging Workup: PET/CT
-used for
-limitation

A

-staging , assessment of response to neoadjuvant tx , RT planning

-spill over uptake from adjacent primary

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14
Q

Gastrointestinal endoscopic mucosal resection (EMR)

A

remove precancerous, early-stage cancer or other abnormal tissues (lesions) from the digestive tract.

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15
Q

Esophagogastroduodenoscopy (EGD)

A

is a procedure to diagnose and treat problems in your upper GI (gastrointestinal) tract

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16
Q

Diagnostic Workup: Summary

A

EGD w biospy/ EMR and EUS to determind cell type cG cT cN.
followed by FDG-PET/CT for additional cN and cM staging.

17
Q

staging :T

A

T1= restricted to supprotive tissue
T2= invades msucular tissue
T3= invades outer membrane
T4= invades nearby structures

18
Q

Treatment Options depends on

A

-performance status
-nutritional status
-co-morbidity evaluation
-pulmonary function test

19
Q

Treatment Options: Endoscopic Therapy

A

Endoscopic Mucosal Resection (EMR)
Argon plasma coagulation (APC)
Photodynamic therapy
Radiofrequency ablation
Cryotherapy

20
Q

Endoscopic Therapy: when is it used

A

barrett oesophagus and very early stage tumours:
Tis, T1a
flat lesion less than 2cm
well differentiated

*this patient group is increasing due to screening of BARRETT Oesophagus and impact of GORD

21
Q

Endoscopic Therapy side effects

A

chest pain
stricture
bleeding w APC
ulceration w APC

22
Q

Treatment option :Surgery (oesophagectomy)
used when

A

-early stage tumours (T1b -T2N0, less than 3 cm, well. differentiated)

-If local node met is present NOT a contraindictation for surgery. Resected w primary

23
Q

Treatment Options: Chemoradiation
used for

A

locally advanced stage disease:
T2 N0 ( greater than 3cm, poorly differentiated) or T1-T3 N1-3 M0

either neoadjuvant or definitive

24
Q

neoadjuvant treatment
takes place:
stage of cancer:

A

-4-8 weeks prior surgery
-T1-2 N1M0or T3-4 N0 M0

25
Q

neo-adjuvant chemoradiation doses

A

45Gy/25#/1.8
50Gy/25#/2
50.4Gy/28#/1.8

26
Q

definitive chemoradiation

A

-patient not surgical candidate
-resectable cancer((T1-3 N0-1) but not surgical candidate due to patient factors
-unresectable middle and lower third carcinoma (T3-4 N0-1 M0)

27
Q

Treatment Options: Summary by Stage
T1a N0 M0

A

-Typically discovered during screening for Barrett oesophagus
-very low chance 2-5% chance of nodal involvement when confined to mucosa
-endoscopic mucosal resection EMR
-Well differentiated mucosal lesions <2cm in size

28
Q

Treatment Options: Summary by Stage
T1B N0 M0

A

-tumour invades submucosa
-when infiltrated to deep submucosa, chance of LN involvement incease up to 45%
-Oesophagectomy

29
Q

Treatment Options: Summary by Stage
T1-T3 N1-3 M0 or T2-T3 N0 M0

A

-depth of tumour invasion ↑ , risk of undetected involved nodes ↑
-neoadjuvant chemoRT followed by surgery (restaging w PET/CT)
-patient ≠. surgical candidate then definitive chemoRT

30
Q

Treatment Options: More Advanced
Disease

A

chemo
RT
chemoRT

31
Q

RT: CT Simulation

A

supine
knee support
distal oesophagus=arms up and immobilised+indexed wing board/vacbag
upper= neck mask

32
Q

RT: CT Simulation
-slice thickness
-scan length
-contrast
-prep
- what is used

A

-2.5mm
-thoracic inlet to mid abdomen (ensure entire lung volume is included for DVH)
-IV contrast may be used to assist in target localisation
-consider empty stomach for distal and GOJ tumours
- 3DCT used as a minimum

33
Q

CT Simulation: Motion Management
-tumour position varies based on

A

-pulmonary and cardiac motion
-swallowing and peristalsis
-gastric filling and emptying

34
Q

Motion observation and management allows for generation of an
Internal Target Volume

A

-ICRU 62
-ITV accounts for tumour motion and ensures adequate CTV coverage
-helps w prediction of target position and enable asymmetric margins

35
Q

CT Simulation: Motion Management options

A

-4DCT w RPM
-inspiration/expiration scans
-DIBH
-ABC
-forced shallow breathing thru abdominal compression

36
Q

RT Planning: Target Volumes
-recommended
-limitation

A

fuse PET/CT w planning CT for target delineation

-variability and accuracy of image fusion
-patient position at scanning (arms up or down)

37
Q

Treatment options:summary by stage

T1a N0 M0

A

-tumour invades lamina propria or muscularis mucosae
-discovered during screening for Barrett oesophagus
- (2-5%) chance of nodal involvement when confined to the mucosa
-Endoscopic mucosal resection (EMR)
-Well differentiated mucosal lesions <2cm in size

38
Q

Treatment options:summary by stage

T1b N0 M0

A

-Tumour invades submucosa
-When infiltrated to the deep submucosa chance of LN involvement increases up to 45%
-Oesophagectomy

39
Q

T1-T3 N1-3 M0 or T2-T3 N0 M0

A

-As depth of tumour invasion increases so too does risk of
undetected involved nodes
-Neoadjuvant chemoRT followed by surgical resection
– Restaging with PET/CT is recommended
-If patient not a surgical candidate, then definitive
chemoRT

3rd Year Semester 1 (55 decks)

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