Oesophageal Cancer Flashcards
What are the causes of dysphagia?
Malignancy, achalasia, hiatus hernia, muscular disease (myasthenia gravis), neurological (stroke, parkinson’s), impaired coordination, GORD, fibrous sacs
What are the features of oropharyngeal dysphagia?
Difficulty initiating swallow ± choking or aspiration
What are the features of oesophageal dysphagia?
Food ‘sticking’ after swallowing ± regurgitation
How do you investigate oropharyngeal dysphagia?
Videofluoroscopic swallowing assessment and neurological investigation
How do you investigate oesophageal dysphagia?
Endoscopy and biopsy
How is achalasia investigated for?
Manometry/barium swallow
What is achalasia?
Oesophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES).It is characterized by incomplete LES relaxation, increased LES tone, and lack of peristalsis of the oesophagus
What are the complications of dysphagia?
Choking, pulmonary aspiration, malnutrition
How is dysphagia managed?
Muscle exercises (SALT), soft food, surgery, tube feeding
What are upper GI red flags?
Weight loss, haematemesis, changed in bowel habit (malaena), pain, symptoms of anaemia
What is barrett’s oesophagus?
oesophageal squamous epithelium undergoes columnar change with metaplasia which predisposes to the development of oesophageal adenocarcinoma
What are the steps in development of oesophageal adenocarcinoma?
oesophagitis, metaplasia, dysplasia, and finally adenocarcinoma
Who requires endoscopic surveillance?
Patients with barrett’s oesophagus and low-grade dysplasia
Who should be screened for barrett’s oesophagus?
o People with chronic or severe GORD (duration >5 years or at least twice weekly symptoms or symptoms interfering with daily activity)
o And at least three of: Age >50 years Male sex White race Obese Smoking
Or
Family history of Barrett’s oesophagus or oesophageal adenocarcinoma
How is barrett’s oesophagus diagnosed?
Salmon coloured columnar epithelium is clearly visualised to extend above the gastro-oesophageal junction during endoscopy
Histopathological examination shows specialised columnar epithelium or intestinal metaplasia.
How is barrett’s managed?
Symptom control of GORD, long-term endoscopic surveillance, endoscopic eradication if dysplasia confirmed
What is done in cases of low-grade dysplasia?
immunohistochemical staining for p53 protein overexpression
What is progressive dysphagia for solids suggestive off?
mechanical obstruction or stricture
What is a difficulty swallowing fluids more suggestive off?
Neurological causes and achalasia
What investigations need to be carried out for suspected oesophageal cancer?
Blood - FBC (anaemia), U&Es, LFTs OGD/gastroscopy ± biopsy CT TAP PET cardioresp fitness
Who requires referral under the urgent suspected cancer referral (2-week) pathway
in people with: - with dysphagia or - aged 55 and over with weight loss and any of the following: • upper abdominal pain • reflux • dyspepsia
What is an MDT meeting?
All patients with suspected cancers are discussed at one of the regular multidisciplinary team meetings. The results of all their investigations are reviewed and the proposed treatment plan is documented. Further investigations and appointments are arranged following the meeting.
What type of cancer is smoking and alcohol linked with?
Squamous cell and adenocarcinoma
How is oesophageal cancer managed?
metastatic/T4 - palliative
Stage T1/T2 NO - endoscopically resect cancer
Stage T3N0/T1N1/T2N1 - pre-op chemoradiation and then re-evaluate for surgery
