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2017 CSB032 Radiation Therapy 2 > Oesophageal Cancer > Flashcards

Oesophageal Cancer Flashcards

1
Q

What is the definition of Aetiology

A

The study of a cause of a disease/ illness

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2
Q

What is the definition of Epidemiology

A

A branch of medicine that deals with the incidence, control and distribution of diseases

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3
Q

What are two types of oesophageal cancer

A

Adenocarcinoma and Squamous Cell Carcinoma

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4
Q

Describe the INCIDENCE of oesophageal cancer

A 
2.2% of all cancers 
6th cause of cancer death worldwide 
5 year survival is less than 25% 
It is rarely seen in people below 25
It peaks in individuals 60-70
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5
Q

What are risk factors of squamous cell oesophageal cancer?

A 
Tobacco and Alcohol
Diet
Achalasia
Head and Neck Cnacer 
Tylosis, Coeliac disease and Lye ingestion
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6
Q

What are risk factors of adenocarcinoma oesophageal cancer?

A

Barrett’s oesophagus
Chronic reflux
Smoking
Obesity

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7
Q

Endemic Oesophageal cancer

A

?

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8
Q

Endemic Oesophageal cancer

A

?

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9
Q

What is some basic anatomy of the oesophagus?

A

runs from cricoid cartilage to O-G junction
Average length is 25cm
Split into 2 parts: Cervical and Thoracic
Outer layer is longitudinal muscle
Inner layer is circular muscle

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10
Q

OESPHAGEAL LYMPH NODES

A

see slide 8

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11
Q

What is the natural history (prognosis) of oesophageal cancer

A

90% dead within 5yrs
30% present with localised disease, 40-50% operable
Local relapse most common problem (SCC)
Systemic spread also a problem

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12
Q

What is the most common route of spread?

A

Sub-mucosal spread is most common.

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13
Q

Where can CERVICAL oesophageal cancer spread to?

A

Cervical oesophagus can spread to: carotids, pleura, recurrent laryngeal nerve, treachea

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14
Q

Where can MIDDLE THIRD oesophageal cancer spread to?

A

bronchi, thoracic duct, aortic arch, azygos vein, right pleura

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15
Q

Where can LOWER THIRD oesophageal cancer spread to?

A

Pericardium, left pleura, descending aorta

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16
Q

What are symptoms of Oesophageal cancer?

A 
Dysphagia- difficulty swallowing
Anorexia 
Weight loss
Pain
Vomiting 
Symptoms dependent on location of tumour
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17
Q

How is Oesophageal cancer diagnosed?

A 
Endoscopy
Barium swallow 
Histology
Panendoscopy
Laparoscopy
PET/CT
CT Scan 
Endoscopic ultrasound
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18
Q

Why is staging important?

A

To define the extent of the primary lesion
To exclude metastatic disease
To quantify co-morbidity and assess suitability for therapy

19
Q

Describe Stage 1 of oesophageal cancer?

A

T0 N0 M0

60% chance of 5 year survival

20
Q

Describe Stage 2 of oesophageal cancer?

A

T2-3,N0 M0

31% of 5 year survival

21
Q

Describe Stage 3 of oesophageal cancer?

A

T3 N1 M0

20% chance of 5 year survival

22
Q

Describe Stage 4 of oesophageal cancer?

A

any T, any N, MI

4% chance of 5 year survival

23
Q

What is the histology of oesophageal cancer?

A

50% are squamous cell carcinomas
48% are Adenocarcinomas

The other 2% include: leiomyo-sarcoma, carcinoid, lymphoma, small cell carcinoma

24
Q

What are curative techniques for oesophageal cancer?

A

Surgery
Radiation Therapy
Combined therapy
- CT/RT

25
Q

What is the ideal for of treatment?

A

surgery - resecting the tumour.

26
Q

What are some reasons for surgical failures

A 
high frequecny of nodal involvment 
spread to surronding organs 
Advanced at presentation (because it asymptomatic)
Patient is medically unfit for surgery
Patient refuses surgery
27
Q

What is the survival rate for surgery?

A

5 year survival rate 15-39%

Surgical mortality 4-10%

28
Q

How is the CERVICAL oesophagus treated?

A

The surgery for cervical oesophageal cancer is quite radical and involves removing the pharynx (loss of voice)
thus chemo and radiation are the most common treatments.
Treated like a Head and Neck cancer (shell)
Overall survival @ 10 years 27%

29
Q

What are the disadvantages SOLE Radiation therapy of oesophageal cancer

A

Local control limited by normal tissue constraints

Longer duration of treatment leads to more adverse symptoms

9% 2 year Survival rate
6% 5 year Survival rate

30
Q

Who are the ideal candidates for chemo/radiation therapy

A

people with localised disease (who arent fit for surgery)
localised SCC - Very small tumours
people with upper third lesions

31
Q

Is concurrent CT/RT better that just RT

A

For Ct/RT
the local recurrence is reduced by 12% (when compared to just RT)

However the toxicity is increased by 17%

32
Q

Is surgery after CT/RT a good idea

A

The chance of surgical morbidity is increased. However local control (from the CT/RT) is improved.
Their are also fewer interventions required for dysphagia (difficulty swallowing)

Overall the survival chance is equal

33
Q

What are the goals of palliative treatment in oesophageal cancer?

A

restore or maintain swallowing
Manage pain
Prevent bleeding

34
Q

Who are the ideal candidates for palliation

A

people with local symptoms and distant metastatic disease
People with inadequate respiratory function
Patients with a poor performance status
Patients with very large tumours

35
Q

What are methods of palliative treatment

A 
Radiation therapy -EBRT, 
Brachytherapy,
Chemotherapy- no evidence of benefit
Stenting 
LASER
36
Q

Why is the simulation/ CT stage important

A

important for:
delineation of GTV
lung DVH’s
Spinal cord delineation

37
Q

What immobilisation devices are used

A

oesophageal board - arms up
head and neck shell- for cervical oesophagus
Orfit

38
Q

What are the planning margins for oesophageal cancer?

A

GTV= gross tumour volume
CTV= GTV plus 2 -2.5 cm margin radially
3-4cm sup&inferior
PTV= CTV plus 0.7cm

39
Q

What are the usual field arrangements for oesophageal radiation.

A

ANT, POST, LEFT LAT, RIGHT LAT

ANT, POST and obliques
for palliative- Parallel opposed

40
Q

What are common dose fractionations

A

Radical CT/RT
- 50.4 Gy/1.8-2.0 fractions

Radiation (SOLE MODALITY) - 60-66 gy
Palliation
- RT alone 35-45 Gy/15-25#
TROG trial: 45Gy/15#/cisplatin/5FU

41
Q

What are organs at risk with the oesophagus

A

Lung - anything that receives more than 20Gy is destroyed
limit the vlume of lung receiving more than 20Gy to 30-35%

Spinal cord limited to more than 46GY @2gy fractions

Cervical oesophagus may allow 50Gy/30# to cord

42
Q

What are acute side effects of treatment

A 
Lethargy
Skin erythema
Dysphagia - difficulty swallowing
Odynophagia - painful swallowing 
Risk of neutrpaeni sepsis 
Percarditis - inflammation of pericardium
43
Q

What are late side effects of treatment

A

pulmonary fibrosis
second malignancy
Hypothyroidism- under active thyroid
Increased risk IHD- ischaemic heart disease
Benign stricture- narrowing of oesophagus

2017 CSB032 Radiation Therapy 2 (6 decks)

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