Oesophageal Cancer

Question 1

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

Answer 1

3 - 10 cases per 100,000

More common in males 4:1

Question 2

At what age does the incidence of oesophageal cancer peak?

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

Answer 2

2 - 60-70

Question 3

How long is the oesophagus generally?

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

Answer 3

3 - 25-27cm

Question 4

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

Answer 4

4 - abdominal

Question 5

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

Answer 5

4 - serosa

• surrounded by adventitia allows binding to surrounding tissues

Question 6

What is the cell type of the oesophagus?

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

Answer 6

2 - stratified squamous cell

Question 7

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

Answer 7

• adenorcarcinoma

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

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

Answer 10

3 - 15%

Question 11

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

Answer 11

4 - alcohol

Question 12

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)

Answer 12

2 - barretts oesophagus

Question 13

At what age does oesophageal cancer normally increase?

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

Answer 13

3 - >50y/o

Incidence typically peaks at 60-70 y/o

Question 14

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

Answer 14

• men

Question 15

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

Answer 15

1 - dysphagia

Question 16

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?

Answer 16

• neuromuscular problem
• achalasia for example

Question 17

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?

Answer 17

• mechanical obstruction
• could be a tumour, stricture etc..

Question 18

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

Answer 18

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

NICE guidelines in the image

Question 19

What is the primary method for diagnosing oesophageal cancers?

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

Answer 19

1 - Oesophago-Gastro-Duodenoscopy

• biopsies can also be taken for histology

Barium swallow test can identify masses, strictures etc..

Question 20

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

Answer 20

2 - CT
- CT-PET can also be useful

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

Question 21

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%

Answer 21

3 - 35 - 45%

Question 22

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

Answer 22

1 - endoscopic or primary surgery

Question 23

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

Answer 23

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

Question 24

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

Answer 24

3 - chemotherapy and/or radiotherapy, immunotherapy

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

Question 25

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

Answer 25

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

Question 26

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%

Answer 26

2 - 5 - 10%

Question 27

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)

Answer 27

3 - acute pancreatitis

Question 28

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

Answer 28

2 - liver cirrhosis

Question 29

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%

Question 30

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

Answer 30

2 - oesophageal cancer

Question 31

Endobronchial ultrasound (EBUS) is performed and the image below is provided, showing what? 1 - volvulus 2 - intusseption 3 - oesophageal cancer 4 - pancreatic cancer

Answer 31

3 - oesophageal cancer May see a similar image in gastric cancer

Question 32

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

Answer 32

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.

Question 33

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

Answer 33

2 - granulocyte colony stimulating factors (GCSF)