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RT Yr 2 Sem 1 > Oesophageal Cancer > Flashcards

Oesophageal Cancer Flashcards

1
Q

What is the epidemiology of oesophagus cancer?

A
  • 2.2% of all cancers
  • 6th cause of cancer death
  • 5yr survival <25%
  • 60-70 rys
  • geographic variation
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2
Q

Risk factors of an SCC?

A
  • tabacoo
  • alcohol
  • diet
  • achalasia
  • head and neck cancer
  • tylosis, coeliac disease and lye ingestion
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3
Q

Risk factors of an adenocarcinoma?

A
  • barrett’s oesophagus
  • chronic reflux
  • smoking
  • obesity
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4
Q

What is the make-up of oesophagus cells?

A
  • top 2/3 squamous cells

- lower 1/3 adenocarinoma

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5
Q

What is the aetiology of oesophageal cancer?

A
  • poor nutrition
  • low intake fruit and vegetables
  • drinking hot beverages
  • no sex bias
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6
Q

What is the anatomy of the oesphagus?

A
  • runs from cricoid cartilage to O-G junction
  • 25cm long
  • cervical and thoracic oesophagus
  • outer layer is longitudinal muscle
  • inner layer is circular muscle
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7
Q

What are the nodes and where do they drain to?

A
  1. sub-mucosal plexus
    - internal jugular, peri-tracheal, sub-carinal, peri-oesphageal, peri-aortic, peri-cardical, lesser curve of stomach
  2. lower 1/3
    - L gastric, coeliac nodes
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8
Q

What is the natural history of oesophageal cancer?

A
  • 90% dead in 5 yrs
  • 30% present with localised disease with 40-50% operable
  • local relapse most common problem (SCC)
  • systemic spread is also a problem
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9
Q

What is the most common metasesis of oesophageal cancer?

A
  • sub-mucosal spread
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10
Q

Where does each part of the oesophagus spread?

A

CERVICAL: carotids, pleura, reccurant laryngeal nerce, trachea

MIDDLE THIRD: bronchi, thoracic duct, aortic arch, azygos, R pleura

LOWER THIRD: pericardium, L pleura, descending aorta

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11
Q

What are the signs of oesophageal cancer?

A
  • dysphagia
  • anorexia
  • weight loss
  • pain
  • vomiting
    NOTE: symptoms dependent on location of tumour
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12
Q

What are the methods of diagnosis for oesophageal cancer?

A
  • biopsy
  • barium swallow
  • endoscopy (define site and longitudinal extent)
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13
Q

What are the methods of investigation for oesophageal cancer?

A
  • CT scan
  • endoscopic ultrasound
  • PET/CT
  • full blood examination
  • panendoscopy
  • laparoscopy
  • ECG and respiratory function test
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14
Q

What is a endoscopic ultrasound and what are its limitations?

A
  • used to determine extent of invasion of oesophageal wall
  • not useful when stricture present
  • limited ability to exam nodes immediately adjacent to tumour
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15
Q

What is the staging and % 5yr survival for oesophageal cancer?

A
  • Stage 1 = T0N0M0, 60%
  • Stage 2 = T2-3N0M0, 31%
  • Stage 3 = T3N1M0, 20%
  • Stage 4 = anyT, anyN, M1, 4%
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16
Q

What is the pathology of oesophageal cancer?

A
  • SCC 50%
  • adenocarcinoma 48%
  • other 2% (leiomyo-sarcoma, carcinoid, lymphoma, small cell carcinoma)
17
Q

What are the curative treatments for oesophageal cancer?

A
  • surgery
  • radiation therapy
  • combinded modality therapy (CT/RT or neoadjuvant)
18
Q

What are the main reasons for disease being un-resectable?

A
  • distant metastases
  • disease un-resectable
  • medically unfit for surgery
  • refuse surgery
19
Q

What is the overall survival at 10yrs for cervical oesophageal caner?

A
  • 27%

- 50% retain larynx

20
Q

What are the 2 and 5yr surivial after just RT for oesophageal cancer?

A
  • 9% 2yr

- 6% 5 yr

21
Q

What are aspects that make someone eligable for CT/RT for oesophageal cancer?

A
  • localised, inoperative oesophageal cancer
  • localised SCC (very samll tumour)
  • upper third lesions
  • localised recurrence after surgery
22
Q

What are the benefits of neoadjuvant therapy for oesophageal cancer?

A
  • better oxygenation may lead to better responses
  • tumour response may make surgery easier
  • may increase local and distant control
  • tumour localised easily
  • no post-op complication interfering with therapy
23
Q

What are the options of neoadjuvant therapy for oesophageal cancer?

A
  • RT plus surgery
  • CT plus surgery
  • CT/RT plus surgery
24
Q

What are the adjuvant therapy options and their benefits for oesophageal cancer?

A
  1. surgery plus RT
    - no survival benefit
    - if positive margins, reduces local relapse
  2. surgery plus CT
    - survival benefit for distal adenocarinoma only
25
Q

What are the goals of palliative treatment of oesophageal cancer?

A
  • restore or maintain swallowing
  • manage pain
  • prevent bleeding
26
Q

Who are the candidates for palliation for oesophageal cancer?

A
  • local symptoms and distant metastatic disease
  • poor performance status
  • inadequate respiratory function
  • very large tumours
27
Q

What are the palliative treatment options for oesophageal cancer?

A
  • RT/brachytherapy
  • chemo (no evidence of benefit)
  • stenting
  • laser
28
Q

What are the CTV and PTV margins for oesophageal cancer?

A
  • CTV = 2-2.5cm radially, 3-4cm sup-inf

- PTV = CTV plus 0.7cm

29
Q

What is the field arrangement for oesophageal cancer?

A
  • Ant, post, LT and RT lateral
  • ant/post and obliques
  • for palliative AP-PA fields
  • wedges usually required in laterals
30
Q

What is the dose for radical CT/RT, RT, palliation for oesophageal cancer?

A
  • CT/RT = 50.4Gy in 28#
  • RT = 60-66Gy in 30/33#
  • Palliatvie RT = 35/45Gy in 15/25#
31
Q

What are the OAR for oesophageal cancer?

A
  • lung

- spinal cord <46Gy @ 2Gy#

32
Q

What are the patient managements for radiaiton patients with oesophageal cancer?

A
  • seen daily by RT and nursing
  • seen weekly by RO
  • dietician review
  • analgesics (pain killer)
  • nutritional support
33
Q

What are the acute side effects of oesophageal RT?

A
  • lethargy
  • skin erythema
  • dysphagia
  • odynophagia
  • risk of neutropaenic sepsis
  • pericarditis
34
Q

What are the late side effects of oesophageal RT?q

A
  • pulmonary fibrosis
  • second malignancy
  • hypothyroidism
  • increased risk of ischaemic heart disease
  • benign stricture

RT Yr 2 Sem 1 (5 decks)

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