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a. block e oncology > Oesophageal Cancer > Flashcards

Oesophageal Cancer Flashcards

1
Q

What is the incidence of oesophageal cancer?

1 - 1000 cases per 100,000
2 - 100 cases per 100,000
3 - 10 cases per 100,000
4 - 1 cases per 100,000

A

3 - 10 cases per 100,000

More common in males 4:1

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2
Q

At what age does the incidence of oesophageal cancer peak?

1 - 70-80
2 - 60-70
3 - 50-60
4 - 30-40

A

2 - 60-70

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3
Q

How long is the oesophagus generally?

1 - 2-5cm
2 - 12-15cm
3 - 25-27cm
4 - 35-40cm

A

3 - 25-27cm

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4
Q

The oesophagus is generally 25-27cm long and can be divided into 3 main parts. Which of the following is NOT one of these parts?

1 - cervical
2 - thoracic
3 - aortic
4 - abdominal

A

4 - abdominal

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5
Q

The whole digestive tract has multiple layers. Looking at layers of the small intestines, which layer does the oesophagus NOT have?

1 - mucosa
2 - submucosa
3 - muscularis propria (inner circular and outer longitudinal layer)
4 - serosa
5 - adventitia

A

4 - serosa

  • surrounded by adventitia allows binding to surrounding tissues
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6
Q

What is the cell type of the oesophagus?

1 - simple squamous cell
2 - stratified squamous cell
3 - transitional squamous cell
4 - simple columnar cell

A

2 - stratified squamous cell

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7
Q

Are squamous cell carcinoma or adenorcarcinoma more common in the oesophagus?

A
  • adenorcarcinoma
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8
Q

There are 2 main types of carcinoma of the oesophagus:

  • squamous cell carcinoma
  • adenorcarcinoma

Which 2 parts of the oesophagus do squamous cell carcinoma affect?

1 - upper 1/3
2 - middle 1/3
3 - lower 1/3
4 - all of the above

A

1 - upper 1/3
2 - middle 1/3
- accounts for aprox 15% of oesophageal cancers

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9
Q

There are 2 main types of carcinoma of the oesophagus:

  • squamous cell carcinoma
  • adenorcarcinoma

Which 2 parts of the oesophagus do adenorcarcinoma affect?

1 - upper 1/3
2 - middle 1/3
3 - lower 1/3
4 - all of the above

A

3 - lower 1/3

  • primarily due to Barrett oesophagus
  • accounts for aprox 15% of oesophageal cancers

Risk factors are likely to affect the lower part of the oesphagus:

  • gastro-oesophageal reflux disease (GORD)
  • Barretts oesophagus
  • obesity
  • alcohol
  • smoking
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10
Q

What is the overall 5 year survival rate of a patient with oesophageal cancer?

1 - 0.15%
2 - 1.5%
3 - 15%
4 - 30%

A

3 - 15%

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11
Q

In the western world there is a higher incidence of adenocarcinomas, which has a number of risk factors for developing oesophageal cancer. Which if the following is NOT a common risk factor for adenocarcinoma?

1 - gastro-oesophageal reflux disease (GORD)
2 - Barretts oesophagus
3 - obesity
4 - alcohol
5 - smoking

A

4 - alcohol

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12
Q

In asian countries there is a higher incidence of squamous cell carcinoma, that has a number of risk factors for developing oesophageal cancer. Which if the following is NOT a common risk factor?

1 - smoking
2 - barretts oesophagus
3 - poor diet
4 - alcohol
5 - nitrosamines (diet)

A

2 - barretts oesophagus

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13
Q

At what age does oesophageal cancer normally increase?

1 - >20y/o
2 - >40y/o
3 - >50y/o
4 - >80y/o

A

3 - >50y/o

Incidence typically peaks at 60-70 y/o

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14
Q

Are men or women at a higher risk of developing oesophageal cancers?

A
  • men
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15
Q

All of the following are clinical presentations of oesophageal cancers. But what is often the most common first presenting sign?

1 - dysphagia
2 - haemoptysis
3 - new or worsening of GORD
4 - weight loss due to reduced intake
5 - retrosternal epigastric pain
6 - horseness

A

1 - dysphagia

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16
Q

When we look at dysphagia, this can be with liquid and/or solids. If a patient is having difficulty with both solids and liquids is this likely to be a neuromuscular problem or a mechanical obstruction?

A
  • neuromuscular problem
  • achalasia for example
17
Q

When we look at dysphagia, this can be with liquid and/or solids. If a patient is having difficulty with solids that may then progress to liquids, is this likely to be a neuromuscular problem or a mechanical obstruction?

A
  • mechanical obstruction
  • could be a tumour, stricture etc..
18
Q

Which of the following patients would be referred on a 2 week referral for potential oesophageal cancer?

1 - >30 y/o with dysphagia, weight loss and reflux
2 - >55 y/o with dysphagia
3 - >25 y/o with dysphagia, weight loss and reflux
4 - >55 y/o with dysphagia, weight loss, reflux, dyspepsia and upper abdo pain

A

4 - >55 y/o with dysphagia, weight loss, reflux, dyspepsia and upper abdo pain

NICE guidelines in the image

19
Q

What is the primary method for diagnosing oesophageal cancers?

1 - Oesophago-Gastro-Duodenoscopy
2 - CT
3 - MRI
4 - endoscopic ultrasound

A

1 - Oesophago-Gastro-Duodenoscopy

  • biopsies can also be taken for histology

Barium swallow test can identify masses, strictures etc..

20
Q

What is often the primary method for staging oesophageal cancers once they have been diagnosed?

1 - Oesophago-Gastro-Duodenoscopy
2 - CT
3 - CT-PET
4 - endoscopic ultrasound
5 - staging laparoscopy

A

2 - CT
- CT-PET can also be useful

  • all of these methods can be used, it just depends on what the staging
21
Q

Early diagnosis and treatment is paramount in patients with oesophageal cancer. What % of patients have the potential of curative therapy?

1 - 0.35 - 0.45%
2 - 3.5 - 4.5%
3 - 35 - 45%
4 - >70%

A

3 - 35 - 45%

22
Q

If a patient has early disease of oesophageal cancer that has not spread beyond the layers of the oesophagus. Which of the following is the most appropriate treatment?

1 - endoscopic or primary surgery
2 - multimodal therapy (chemotherapy and/or radiotherapy, surgery)
3 - chemotherapy and/or radiotherapy, immunotherapy
4 - immunotherapy

A

1 - endoscopic or primary surgery

23
Q

If a patient with locally advanced (local lymph notes and tissues) oesophageal cancer, which of the following is the most appropriate treatment?

1 - endoscopic or primary surgery
2 - multimodal therapy (chemotherapy and/or radiotherapy, surgery)
3 - chemotherapy and/or radiotherapy, immunotherapy
4 - immunotherapy

A

2 - multimodal therapy (chemotherapy and/or radiotherapy, surgery)

24
Q

If a patient has a pallative diagnosis for oesophageal cancer, which of the following is the most appropriate treatment?

1 - endoscopic or primary surgery
2 - multimodal therapy (chemotherapy and/or radiotherapy, surgery)
3 - chemotherapy and/or radiotherapy, immunotherapy
4 - immunotherapy

A

3 - chemotherapy and/or radiotherapy, immunotherapy

  • could also be just immunotherapy alone
  • could also have stenting to help symptoms
25
Q

In a surgery for oesophageal cancer, it is normally performed in a 2 stage process: abdominal and thoracic phase. Re-organise the order of the surgery using the labels below:

1 - dissect surrounding lymph nodes
2 - open up thoracic cavity to dissect diseases oesophagus and tumour
3 - connect stomach to left over oesophagus and anastomose
4 - laparotomy to open the abdomen and mobilise the stomach

A

1 - laparotomy to open the abdomen and mobilise the stomach
2 - open up thoracic cavity to dissect diseases oesophagus and tumour
3 - dissect surrounding lymph nodes
4 - connect stomach to left over oesophagus and anastomose

  • Lewis and Mckeown are most commonly used approaches
26
Q

Following surgery for oesophageal cancer, what % of patients die within 30 days?

1 - 0.5 - 1.0%
2 - 5 - 10%
3 - 50 - 100%
4 - >70%

A

2 - 5 - 10%

27
Q

Which of the following is NOT a common short term complication of surgery for oesophageal cancer?

1 - anastomotic leak
2 - recurrent laryngeal nerve injury
3 - acute pancreatitis
4 - gastric necrosis
5 - chylothorax (damage to lymphatic system)

A

3 - acute pancreatitis

28
Q

Which of the following is NOT a common long term complication of surgery for oesophageal cancer?

1 - depression
2 - liver cirrhosis
3 - nutritional deficits
4 - recurrence

A

2 - liver cirrhosis

29
Q

Survival following curative intent:
- 74% at 1 year
- 30% at 4 years

Survival based on treatment stage:
- stage 1 - 70%
- stage 2 - 48%
- stage 3 - 36%
- stage 4 - 14%

A
30
Q

58 year old man who smokes, drinks 25u/ week has had some weight loss and a gradual worsening dysphagia for the past 4/12 in solids. He has noticed a recent rapid deterioration in dysphagia in both solids and fluids and is now vomiting up water. What is the most likely diagnosis?

1 - achalasia
2 - oesophageal cancer
3 - GORD
4 - anorexia nervosa

A

2 - oesophageal cancer

31
Q

Endobronchial ultrasound (EBUS)
is performed and the image below is provided, showing what?

1 - volvulus
2 - intusseption
3 - oesophageal cancer
4 - pancreatic cancer

A

3 - oesophageal cancer

May see a similar image in gastric cancer

32
Q

A patient diagnosed with oesophageal cancer is having swallowing fluids and solids. What is the best method of ensuring the patient is able to eat and drink?

1 - orally following blending
2 - radiologically inserted gastrostomy (RIG)
3 - percutaneous endoscopic gastrostomy
4 - parenteral nutrition

A

2 - radiologically inserted gastrostomy (RIG)

Side effects include diarrhoea

Percutaneous endoscopic gastrostomy requires a camera to be passed down the oesophagus, so this would be inappropriate.

33
Q

If a patient develops neutropenic sepsis due to the cancer treatment, in addition to initiating the sepsis 6, what can be given in an attempt to increase the neutrophil count?

1 -dexamethasone
2 - granulocyte colony stimulating factors (GCSF)
3 - blood transfusion
4 - frozen WBCs

A

2 - granulocyte colony stimulating factors (GCSF)

a. block e oncology (17 decks)

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