Oesophageal cancer

Question 1

Epidemiology of oesophageal carcinoma?

Answer 1

• 3M:1F
• Onset 50 - 60y
• Types:
• -SCC in upper 2/3
• -Adenocarcinoma distal 1/3

Question 2

RFx oesophageal carcinoma?

Answer 2

• Geographic variance
• SCC:
• ->underlying disease (strictures, diverticula, achalasia)
• ->More common in Asians
• Adenocarcinoma
• ->BE (most imp), smoking, obesity, GORD>

Question 3

4Ss of SCC?

Answer 3

i) Smoking
ii) Spirits (alcohol)
iii) Seeds (betel nut)
iv) Scalding (hot liquid)

Question 4

CFx oesophageal Ca?

Answer 4

• Frequently asymptomatic (late presentation)
• Progressive mechanical dysphagia
• Constitutional symptoms
• Regurgitation and aspiration
• Tracheoesophageal / bronchoesophageal fistual

Question 5

Where does oesophageal ca spread?

Answer 5

• Trachea (coughing)
• Recurrent laryngeals (hoarseness, vocal paralysis)
• LNs: aortic, liver, lung, bone, celiac and mediastinal nodes.

Question 6

Ix in oesophageal Ca?

Answer 6

• Barium swallow: narrowing
• Oesophagoscopy: biopsy and assess respectability
• Endoscopic U/S: local disease, nodal involvement (most useful for staging)
• Full met work up (CXR, bone scan, CT head/CAP, LFTs etc)

Question 7

Rx of oesophageal ca with distant metastatic disease?

Answer 7

Systemic therapy and treat symptoms (oesophageal stent)

Question 8

Rx of locally advanced oesophageal Ca (locally invasive or nodal disease)?

Answer 8

Multimodal therapy:

• concurrent radiation and chemotherapy (cisplatin and 5-FU)
• possibility of curative oesophagectomy after chemoradiation if good response.

Question 9

Rx of early stage oesophageal Ca (non-transmural, no LN involvement)?

Answer 9

Oesophagectomy (transthoracic or trans hiatal) + lymphadenectomy.

Question 10

Staging investigation in oesophageal cancer?

Answer 10

• Endoscopy and biopsy
• CT C/A -> Mets
• PET scan -> mets
• Staging laparoscopy
• Bronchoscopy for mid oesophageal tumours