Oesophageal Cancer

Question 1

Types of Oesophageal Cancer

Answer 1

Squamous Cell Carcinoma

Adenocarcinoma

Question 2

Presentation of Oesophageal Cancer

Answer 2

Progressive Dysphagia (90%)
Anorexia (75%)
Odynophagia (pain while swallowing)
Chest Pain 
Cough 
Pneumonia (Tracheo-oesophageal Fistula)
Vocal Cord Paralysis
Haematemesis

Question 3

Where does Squamous Cell Carcinoma occur

Answer 3

Proximal 2/3 of Oesophagus

Question 4

What is Squamous Cell Carcinoma associated with

Answer 4

Achalasia
Caustic Stricture
Plummer-Vinson Syndrome

Question 5

Where does Adenocarcinoma occur

Answer 5

Distal 1/3 of Oesophagus

Question 6

What is Adenocarcinoma associated with

Answer 6

Barret’s Oesophagus (Progression through Dysplasia to cancer)

Question 7

When does Oesophageal Cancer usually present

Answer 7

Late

Tumours have commonly spread to Regional Lymph Nodes and/or liver at presentation

Question 8

What often limits Surgerical Intervention

Answer 8

Local Invasion (heart, trachea, aorta)

Question 9

Common Metastases

Answer 9

Hepatic
Brain
Pulmonary
Bone

Question 10

Prognosis

Answer 10

Poor - 5 year survival ~10%

Question 11

What investigation can diagnose Oesophageal Cancer

Answer 11

Endoscopy and Biopsy

Question 12

How is Oesophageal Cancer staged

Answer 12

CT
PET Scan
Bone Scan
and using TNM Classification

Question 13

Oesophageal Cancer Treatment

Answer 13

Surgical Oesophagectomy (only potential cure) +/- adjuvant (after) or neoadjuvant (before) Chemotherapy

Combined Chemotherapy and Radiotherapy offer some prospect of improved long-term survival (in 1yr) in patients with Locally Advanced Inoperable Disease