Oesophageal cancer

Question 1

What are the two types of oesophageal cancers?

Answer 1

Squamous cell carcinoma (SCC) or Adenocarcinoma (ACA)

Squamous cell carcinoma is usually proximal and adenocarcinoma is usually distal.

Question 2

Where do oesophageal cancers tend to occur?

Answer 2

20% occur in the upper part, 50% in the middle and 30% in the lower part

Question 3

What are the risk factors for oesophageal cancer?

Answer 3

Smoking/alcohol

Dietary factors - diet lacking in vegetables/fruit/dairy products – linked with SCC

Low Folate (vegetables/fruits/) is linked with oesophageal cancer

Diet with low vit A, C, riboflavin – linked with SCC

Consumption of pickles

Iron deficient anaemia through the Paterson-Brown-Kelly syndrome – linked with SCC

High BMI

Reflux disorder & Barrett’s Oesophagus
o Reflux once a week = x8 increased risk of oesophageal cancer
o Reflux at night = x11 increased risk of oesophageal cancer
o Reflux for >20 years with severe symptoms = x43.5 increased irks of oesophageal cancer

Question 4

How does oesophageal cancer present?

Answer 4

• Dysphagia
• Weight loss
• Retrosternal chest pain
• Upper 1/3 of the oesophagus = hoarseness, cough

Question 5

When should a patient be referred under the 2-week rule?

Answer 5

Dysphagia combined with one or more of the alarming symptoms:

1. Weight loss
2. Anaemia
3. Anorexia
4. Persistent vomiting

Dyspepsia at any age combined with any of the following symptoms:

1. Weight loss
2. Anaemia
3. Anorexia

Dyspepsia in a patient aged 55 years or more with at least one of the high risk symptoms:

1. Onset less than 1 year ago
2. Continuous symptoms since onset

Dyspepsia combined with one of the following:

1. Family H/O upper GI cancer in more than 2 1st degree relatives
2. Barret’s oesophagus
3. Known, dysplasia, metaplasia, atrophic gastritis

Question 6

How is oeosphageal cancer investigated?

Answer 6

• Oesophageal + gastric endoscopy with biopsy
• Bloods - anaemia?
• ECG, lung function test, CXR – assess general health and suitability for surgery
• CT scan – staging of the cancer
• Oesophageal USS
• PET scan –
• Laparoscopy – to assess for metastasis in peritoneum

Question 7

How is oesophageal cancer treated?

Answer 7

• Surgery – open vs laparoscopic
• Chemotherapy – neoadjuvant/ definitive/ palliative
• Radiotherapy for SCC
• Endoscopic resection
• Combination
• Palliative – stenting/ PEG/ PEJ/ jejunal feeding/ surgical bypass /paracentesis (abdominal drainage) drugs etc