Oesophageal cancer

Question 1

Who gets oeosophageal cancer

Answer 1

60-70 years
Males 4:1 women

Question 2

Risk factors for adenocarcinoma of oesophagus

Answer 2

GORD
Barretts oesophagus
SMoking
Obesity

Question 3

Squamous cell cancer risk factors oesophagus

Answer 3

Smoking
Alcoohl
Achalasia
Plummer-vinson syndrome
Diet rich in nitrosamines

Question 4

Where is affected by adenocarcinoma of oeospohagus

Answer 4

Lower third - near GO junction

Question 5

Where is affected by SCC of oeospohagus

Answer 5

Upper 2/3s of oesophagus

Question 6

Presenting features of oesophageal cancer

Answer 6

Often presents at advanced stage as early asynptomatic
Dysphagia - difficulty swallowing
Weight loss
Odynophagia - pain swallow
Hoarseess - pressing on recurrent laryngeal nerve
Retrosternal pain or discomfort
Regurgitation or vomitting undigested food

Question 7

Urgent endscopy for oesophageal cancer offere dwhen

Answer 7

Dysphagia or
>55 and weight loss with any of
-upper abdo pain
-reflux
-Dyspepsia

Question 8

Consider non urgent referral for endoscopy for oesophageal cancer in people with

Answer 8

haematemesis
>55 and
-treatment resistant dyspepsia
-upper abdo pain w low Hb levels or
-Raised platelet count and any of: N/V, weight loss, reflux, dyspepsia, upper abdo pain OR
N+V and any of weight lsos, reflux, dyspepsia, upp[er abdo pain

Question 9

Investigaitons ofr oesophageal cancer

Answer 9

First line - endoscopy and biopsy
EUS 0 assess deth and invasion, lymph node involevemny
Barium swallow (not as senstitive)
CT - locoregional invasion and distant mets
PET - occult distnat metastases or synchronous malignancies

Question 10

Primary tumour staging oesophafeal cancer

Answer 10

Tis: Carcinoma in situ, high-grade dysplasia.
T1: Tumour invades the lamina propria, muscularis mucosae, or submucosa.
T1a: Tumour invades the lamina propria or muscularis mucosae.
T1b: Tumour invades the submucosa.
T2: Tumour invades the muscularis propria.
T3: Tumour invades the adventitia.
T4: Tumour invades adjacent structures.
T4a: Resectable tumour invading the pleura, pericardium, or diaphragm.
T4b: Unresectable tumour invading other adjacent structures, such as the aorta, vertebral body, or trachea.

Question 11

N and M staging oesophageal cancer

Answer 11

Regional Lymph Nodes (N)
N0: No regional lymph node metastasis.
N1: Metastasis in 1-2 regional lymph nodes.
N2: Metastasis in 3-6 regional lymph nodes.
N3: Metastasis in 7 or more regional lymph nodes.

Distant Metastasis (M)
M0: No distant metastasis.
M1: Distant metastasis

Stage 0: Tis, N0, M0
Stage I: T1, N0, M0
Stage IIA: T2, N0, M0 or T3, N0, M0
Stage IIB: T1, N1, M0 or T2, N1, M0
Stage III: T3, N1, M0 or T1-3, N2, M0 or T4a, N0-1, M0
Stage IVA: T4a, N2, M0 or T1-4a, N3, M0 or T4b, Any N, M0
Stage IVB: Any T, Any N, M1

Question 12

Treatment for oesophageal cancer

Answer 12

Early stage - oesophagectomy w or without lymphadectomy
Neoadjuvant chemo, adjuvant therapy
Targeted therapy and immmunotherapy
Palleative care - endoscopic stenting, laser ablation, chemo

Question 13

Oesophagectomy main challenge

Answer 13

Anatomotic leak-> intrathoracic anastomosis 0-> mediastinitis

Question 14

Prognosis for oesophageal cancer

Answer 14

Generally poor
5 yeras survival around 20%
Factors: tumor stage, histological subtype, and the presence of distant metastases.