OESOPHAGEAL CANCER Flashcards
What are the two main types of oesophageal cancer?
Adenocarcinoma
Squamous cell carcinoma
Where are most cancers of the oesophagus found?
Lower 2/3rds with 50% occurring in the lowest third
What percentage of diagnosed cancers do oesophageal carcinomas represent?
5%
What is the sequence of pathology in the development of oesophageal adenocarcinoma?
GORD
Barrett’s oesophagus
Invasive adenocarcinoma
What are the oncogenes involved in the development of adenocarcinoma of the oesophagus? Which chromosome are these mutations found on?
p53
LOH
Both on chromosome 17
What percentage of patient’s with Barrett’s oesophagus go on to develop adenocarcinoma of the oesophagus?
About 10%
Where are carcinomas of the oesophagus most likely to spread to?
Local spread: Length of oesophagus Pleura Trachea Bronchi Lung Aorta
Distant metastases via haematogenous or lymphatic spread:
Liver
Lung
Are most oesophageal cancers squamous in nature or adenocarcinomas?
90% are squamous cell carcinomas
Where is the world is oesophageal cancer most commonly seen?
China
Is oesophageal cancer more common in men or women?
Men
What are the risk factors for developing oesophageal cancer?
Smoking
Alcohol
GORD
Rarer:
Achalasia (muscles of the lower part of the oesophagus fail to relax)
Plummer-Vinson syndrome (dysphagia, iron deficiency anemia, and oesophageal webs)
Tylosis (thickening of the skin in the palms of the hands and the soles of the feet)
How might someone with suspected carcinoma of the oesophagus present?
50-80 years old Dysphagia Weight loss Fatigue - anaemia Vomiting Haematemesis Haemoptysis Pain on swallowing (odynophagia) Hoarse voice
May present with cough and dyspnoea - due to aspiration
What investigations would you order in someone with suspected oesophageal cancer?
FBC
LFTs
U&Es
Endoscopy
Barium swallow - for those who cannot tolerate endoscopy
Endoscopic ultrasound and spiral CT - for staging of disease
PET scan or PET/CT
Why would you do LFTs in someone with suspected oesophageal cancer?
Thinking about metastatic spread
Why would you do U&Es in someone with suspected oseophageal cancer?
Dehydration due to dysphagia
What three ways might a cancer of the oesophagus be described from endoscopy?
Protruding - 60%
Excavating - 25%
Flat - 15%
What is the staging process used for oesophageal cancers?
TNM
What does T1 mean with regard to oesophageal cancer staging using the TNM system?
Tumour invades lamina propria or submucosa
What does T2 mean with regard to oesophageal cancer staging using the TNM system?
Tumour invades muscularis propria
What does T3 mean with regard to oesophageal cancer staging using the TNM system?
Tumour invades adventitia
What does T4 mean with regard to oesophageal cancer staging using the TNM system?
Tumour invades adjacent structures
What does N0 mean with regard to oesophageal cancer staging using the TNM system?
No lymph node involvement
What does N1 mean with regard to oesophageal cancer staging using the TNM system?
Confined to local nodes
What does N2 mean with regard to oesophageal cancer staging using the TNM system?
More distant node involvement but still specified for that tumour type. Otherwise classified as M for metastatic.
What is the prognosis for someone diagnosed with oesophageal cancer?
Exceptionally poor - 2-5% survival rate at 5 years
What are the treatment options for someone diagnosed with oesophageal cancer?
MDT
Surgery - only possible cure
Radiotherapy - reduces size of tumour, relieves dysphagia
Laser therapy - relieves dysphagia
Endoscopic placement of expanding metal stent
Brachytherapy - radioactive implants
What is the operative mortality rate for surgical removal of oesophageal malignant tumour?
5-10%
