Oesophageal cancer Flashcards
What are the types of oesphageal cancer?
Adenocarcinoma
Squamous cell carcinoma
What is the pathophysiology of oesophageal adenocarcinoma?
Most commonly arises from Barret’s oesophagus
Where does oesophageal carcinoma most commonly occur?
In the lower third of the oesophagus (near the gasto-oesophageal junction)
What are the risk factors for oesphageal cancer?
Barrett’s oesphagus
Obesity
Smoking
Alcohol
Achalasia
What is the presentation of oesophageal cancer?
Progressive dysphasia
Regurgitation
Odynophagia (painful swallowing)
Weight loss
Anorexia
Hoarseness of voice
Vomiting
Lymphadenopathy
Vocal cord paralaysis
Melaena on DRE
Which patients should be referred for an urgent upper GI endoscopy?
Dysphagia OR
> 55 years with weight loss and one of:
- Epigastric pain
- Reflux
- Dyspepsia
What is the first line investigation for oesophageal cancer?
Upper GI endoscopy and biopsy
What investigations are used to stage oesophageal cancer?
CT chest, abdomen and pelvis (first line staging)
Endoscopic ultrasound
Staging laparoscopy
PET CT
HER2 testing
What is the management of oesophageal adenocarcinoma?
Surgical resection (only for patients with no metastatic disease)
- Endoscopic mucosal resection - for very early lesions or barrett’s oesophagus
- Ivor Lewis oesophagectomy - most common procedure
- McKeown oesophagectomy - performed for proximal tumours
Chemotherapy - offered to all patients pre-operatively
What is the management of localised oesophageal squamous cell carcinoma?
Radical chemotherapy
What are the complications of oesophageal cancer?
Aspiration pneumonia
Tracheo-oesophageal or broncho-oesophageal fistula
Metastasis
What are the complications of oesophagectomy?
Anastomotic leak
Reccurent laryngeal nerve injury
Delayed gastric emptying
