Oesophageal cancer Flashcards
How many regions does the Oesophagus have?
3
Give the 3 regions of the the oesophagus
cervical, thoracic , abdominal
Give the name of the area where the oesophagus connects to the stomach?
gastro oesophageal junction
What are the layers of the oesophagus?
- Mucosa
- Submucosa
- Muscularis,
- adventitia
What is the mucosa of the oesophagus?
non-keratinised stratified squamous epithelium
What is the role of the mucosa?
- Secretes
- Absorbs
- Protects
What is the sub mucosa of the oesophagus?
contains all the nerves that help contractions and move the food from mouth to stomach
What is the muscularis propria?
circular layer of muscle:
- creates peristalsis
- takes nutrients from the mucosa to the blood stream
What is the lamina propria?
areolar connective tissue underlying a mucous membrane
Where does the cervical region start?
Pharynx
Where does the cervical region drain?
drains into deep cervical nodes
deep lymphatic duct
thoracic duct
tracheobronchial
Where does the thoracic region start?
starts at tracheal bifurcation
Where does the thoracic region drain?
superior and posterior mediastinal nodes
Where does the abdominal region drain?
left gastric and coeliac nodes
What is Barrett’s Oesophagus?
Squamous epithelium of the oesophagus becomes damaged and undergoes metaplasia to gastric mucosa (columnar glandular epithelium)
What is the epidemiology of oesophageal cancer?
15th most common cancer in women
the most common site is the lower 1/3
High in deprived areas
59% of cases are preventable
What are 8 risk factors for oesophagus cancer?
- Age
- obesity
- Adenocarcinoma
- Smoking
- Alcohol
- Barrett’s Oesophagus
- Previous RT
- Drinking very hot drinks
Presentations of oesophageal cancer (10)
- Dysphagia
- Weight loss
- Acid reflux
- Heartburn
- Burping
- Hoarse voice
- Pain
- Polyps
- Loss of appetite
- Nausea and vomiting
What are some investigations for oesophageal cancer?
- Endoscopy
- Biopsy
- Scan for spread
- Barium swallow
- Gastroscopy
What are 4 treatment options?
- Surgery
- Chemotherapy
- Radiotherapy
- Oesophagectomy
What are the two main types of oesophageal cancer?
- Squamous cell carcinoma
- Adenocarcinoma
Where does SCC commonly occur in the oesophagus?
in the middle and upper third of oesophagus
What is SCC of oesophagus commonly associated with?
Smoking and excessive alcohol
Where does adenocarcinoma cancers typically occur?
Adenocarcinoma – more common in high income countries, typically occur in the lower third of the oesophagus, and arises as a consequence of metaplastic epithelium (termed Barrett’s oesophagus) which progresses to dysplasia, to eventually become malignant
Risk factors for this subtype are long-standing GORD, obesity, and high fat intake
Squamous dysplasia- pre cancerous management?
patient encouraged to change lifestyle
* endoscopic mucosal resection
* laser ablation
* balloon cryoablation
What happens in an Endoscopic Mucosal Resection (EMR)?
-Removes superficial lesions or submucosal neoplasms
-Radiofrequency ablation used to kill cancer cells
-Option for some small, very early stage cancers
What is balloon cyroablation?
Balloon catheter inserted and inflated, cells frozen
What surgery would be used?
oesophagectomy
- removal of part of the oesophagus with cancer in it
oesophagus reconnected and stomach pulled further up
transthoracic
Name 7 complications of surgery?
need to go to ICU after due to extensive recovery
swallowing issues
may need permanent PEG
psychosocial support
heart problems
chest infections
blood clots/stroke
What are 3 options to treat dysphagia?
endoscopic dilation
stent
pertucaneous endoscopic gastronomy
