Oesophageal Cancer Flashcards
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
3 - 10 cases per 100,000
More common in males 4:1
At what age does the incidence of oesophageal cancer peak?
1 - 70-80
2 - 60-70
3 - 50-60
4 - 30-40
2 - 60-70
How long is the oesophagus generally?
1 - 2-5cm
2 - 12-15cm
3 - 25-27cm
4 - 35-40cm
3 - 25-27cm
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
4 - abdominal
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
4 - serosa
- surrounded by adventitia allows binding to surrounding tissues
What is the cell type of the oesophagus?
1 - simple squamous cell
2 - stratified squamous cell
3 - transitional squamous cell
4 - simple columnar cell
2 - stratified squamous cell
Are squamous cell carcinoma or adenorcarcinoma more common in the oesophagus?
- adenorcarcinoma
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
1 - upper 1/3
2 - middle 1/3
- accounts for aprox 15% of oesophageal cancers
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
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
What is the overall 5 year survival rate of a patient with oesophageal cancer?
1 - 0.15%
2 - 1.5%
3 - 15%
4 - 30%
3 - 15%
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
4 - alcohol
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)
2 - barretts oesophagus
At what age does oesophageal cancer normally increase?
1 - >20y/o
2 - >40y/o
3 - >50y/o
4 - >80y/o
3 - >50y/o
Incidence typically peaks at 60-70 y/o
Are men or women at a higher risk of developing oesophageal cancers?
- men
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
1 - dysphagia
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?
- neuromuscular problem
- achalasia for example
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?
- mechanical obstruction
- could be a tumour, stricture etc..
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
4 - >55 y/o with dysphagia, weight loss, reflux, dyspepsia and upper abdo pain
NICE guidelines in the image
What is the primary method for diagnosing oesophageal cancers?
1 - Oesophago-Gastro-Duodenoscopy
2 - CT
3 - MRI
4 - endoscopic ultrasound
1 - Oesophago-Gastro-Duodenoscopy
- biopsies can also be taken for histology
Barium swallow test can identify masses, strictures etc..
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
2 - CT
- CT-PET can also be useful
- all of these methods can be used, it just depends on what the staging
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%
3 - 35 - 45%
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
1 - endoscopic or primary surgery
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
2 - multimodal therapy (chemotherapy and/or radiotherapy, surgery)
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
3 - chemotherapy and/or radiotherapy, immunotherapy
- could also be just immunotherapy alone
- could also have stenting to help symptoms
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
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
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%
2 - 5 - 10%
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)
3 - acute pancreatitis
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
2 - liver cirrhosis
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%
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
2 - oesophageal cancer
Endobronchial ultrasound (EBUS)
is performed and the image below is provided, showing what?
1 - volvulus
2 - intusseption
3 - oesophageal cancer
4 - pancreatic cancer
3 - oesophageal cancer
May see a similar image in gastric cancer
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
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.
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
2 - granulocyte colony stimulating factors (GCSF)