OESOPHAGEAL CANCER

Question 0

What is the prognosis? What demographic?

Answer 0

5 year survival < 5%
50 year old male
Uncommon condition but lethal

Question 1

What are types of oesophageal cancer?

Answer 1

Adenocarcinoma MC (Baretts oesophagus) 
Squamous Cell carcinoma

Question 2

Risk factors?

Answer 2

Smoking and alcohol are synergistic 
Chronic damage:
- chronic reflux
- chronic achalasia 
- hot tea
Head and neck cancer

Question 3

Clinical presentation?

Answer 3

Frequently asymptomatic until advanced
Progressive mechanical dysphagja I.e. Solids -> semi-solids -> liquids
Odynophagia
Wt loss, fatigue, anorexia
Hypercalcemia dt bone mets -> osteolysis or PTHrP from cancer release

Question 4

Investigations?

Answer 4

CBE EUC LFTs
RAD 
- endoscopy with biopsy 
- staging Ix
-> EUS for local spread
-> CT chest and ABDO for further spread

Question 5

Treatment?

Answer 5

Surgical - oesophagectomy and lymphadenectomy of all gross tumour

• > feasible in 45% of pts
• > residual cancer often present at margins
• > 5% peri operative mortality

Adjuvant chemo radiotherapy, may be neoadjuvant -> resection afterwards

Focus on symptomatic relief