Oesophageal cancer

Question 1

What is oesophageal cancer?

Answer 1

Malignant tumour arising in the oesophagus. There are TWO major histological types: 
- Squamous cell carcinoma - upper 2/3
- Adenocarcinoma - lower 1/3  

Question 2

What are the causes/ risk factors for squamous cell esophageal carcinoma?

Answer 2

• Alcohol
• Tumour
• Plummer-Vinson syndrome
• Achalasia
• Scleroderma
• Coeliac disease
• Nutritional deficiencies
• Dietary toxins (e.g. nitrosamines – cured meats, pickles)

Question 3

What are the causes/ risk factors for adenocarcinoma, oesophageal cancer?

Answer 3

GORD
Barrett’s oesophagus

Question 4

Summarise the epidemiology of oesophageal cancer

Answer 4

8th most common cancer
3 x more common in MALES
Squamous cell carcinoma is more common in DEVELOPING COUNTRIES
Adenocarcinoma is more prevalent in the WESTERN WORLD

Question 5

What are the presenting symptoms of oesophageal cancer?

Answer 5

• Often ASYMPTOMATIC
• Progressive dysphagia (initially worse for solids then liquids)
• Regurgitation
• Cough
• Choking after food
• Voice hoarseness
• Odynophagia (painful swallowing)
• Weight loss- lack of intake and cancer itself
• Fatigue (due to iron deficiency anaemia)
  1. Signs of Advanced Disease
• Hoarseness → recurrent laryngeal nerve pressed (SCC - Upper 2/3)
• Horner’s Syndrome → ptosis, miosis, anhidrosis
  2. Signs of upper GI Bleeding → Haematemesis, Melaena, Raised Urea
• May have symptoms of anaemia (fatigue, SOB)

Question 6

What signs of oesophageal cancer can be found on physical examination

Answer 6

There may be NO SIGNS
1. Metastatic disease may cause:
- Supraclavicular lymphadenopathy
- Hepatomegaly
- Hoarseness
- Signs of bronchopulmonary involvement

Question 7

What investigations are used to diagnose/ monitor oesophageal cancer?

Answer 7

1. Upper GI Endoscopy with Biopsy → Gold Standard. First test in patients with dysphagia, odynophagia & weight loss. Will differentiate oesophageal cancer from benign causes of dysphagia (eg. achalasia)
2. CT CAP/MRI → for staging. Important for treatment.

Question 8

How is oesophageal cancer managed?

Answer 8

1. Surgery → Oesophagectomy may be tried with adjunct chemotherapy
2. Chemoradiotherapy → better than radiotherapy alone

Question 9

Describe the prognosis of oesophageal cancer

Answer 9

one of the most lethal malignancies. Poor prognosis due to aggressive course & late diagnosis
Ddx ⇒ Achalasia
- incomplete relaxation of LOS
- dysphagia to solids and liquids from the start
- manometry (gold standard) = increased resting pressure on LOS
- barium swallow = birds beak appearance (grossly dilated oesophagus that tapers at the LOS)
- CXR = wide mediastinum, fluid level
- Mx = pneumatic dilatation or heller’s cardiomyotomy (relieves pressure on LOS, only if patients fit to undergo surgery)