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Case 19 Diseases of the Upper GI tract > Oesophageal Cancer > Flashcards

Oesophageal Cancer Flashcards

1
Q

What are the causes of dysphagia?

A

Malignancy, achalasia, hiatus hernia, muscular disease (myasthenia gravis), neurological (stroke, parkinson’s), impaired coordination, GORD, fibrous sacs

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2
Q

What are the features of oropharyngeal dysphagia?

A

Difficulty initiating swallow ± choking or aspiration

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3
Q

What are the features of oesophageal dysphagia?

A

Food ‘sticking’ after swallowing ± regurgitation

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4
Q

How do you investigate oropharyngeal dysphagia?

A

Videofluoroscopic swallowing assessment and neurological investigation

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5
Q

How do you investigate oesophageal dysphagia?

A

Endoscopy and biopsy

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6
Q

How is achalasia investigated for?

A

Manometry/barium swallow

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7
Q

What is achalasia?

A

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

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8
Q

What are the complications of dysphagia?

A

Choking, pulmonary aspiration, malnutrition

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9
Q

How is dysphagia managed?

A

Muscle exercises (SALT), soft food, surgery, tube feeding

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10
Q

What are upper GI red flags?

A

Weight loss, haematemesis, changed in bowel habit (malaena), pain, symptoms of anaemia

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11
Q

What is barrett’s oesophagus?

A

oesophageal squamous epithelium undergoes columnar change with metaplasia which predisposes to the development of oesophageal adenocarcinoma

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12
Q

What are the steps in development of oesophageal adenocarcinoma?

A

oesophagitis, metaplasia, dysplasia, and finally adenocarcinoma

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13
Q

Who requires endoscopic surveillance?

A

Patients with barrett’s oesophagus and low-grade dysplasia

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14
Q

Who should be screened for barrett’s oesophagus?

A

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

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15
Q

How is barrett’s oesophagus diagnosed?

A

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.

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16
Q

How is barrett’s managed?

A

Symptom control of GORD, long-term endoscopic surveillance, endoscopic eradication if dysplasia confirmed

17
Q

What is done in cases of low-grade dysplasia?

A

immunohistochemical staining for p53 protein overexpression

18
Q

What is progressive dysphagia for solids suggestive off?

A

mechanical obstruction or stricture

19
Q

What is a difficulty swallowing fluids more suggestive off?

A

Neurological causes and achalasia

20
Q

What investigations need to be carried out for suspected oesophageal cancer?

A 
Blood - FBC (anaemia), U&Es, LFTs
OGD/gastroscopy ± biopsy
CT TAP
PET
cardioresp fitness
21
Q

Who requires referral under the urgent suspected cancer referral (2-week) pathway

A 
in people with: 
- with dysphagia or
- aged 55 and over with weight loss and any of the following: 
•	upper abdominal pain 
•	reflux
•	dyspepsia
22
Q

What is an MDT meeting?

A

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.

23
Q

What type of cancer is smoking and alcohol linked with?

A

Squamous cell and adenocarcinoma

24
Q

How is oesophageal cancer managed?

A

metastatic/T4 - palliative
Stage T1/T2 NO - endoscopically resect cancer
Stage T3N0/T1N1/T2N1 - pre-op chemoradiation and then re-evaluate for surgery

25
Q

How is cancer managed palliatively?

A

Stenting, PEG tube, PEJ tube, jejunal feeding, surgical bypass, paracentesis (drainage), drugs for symptom control

26
Q

What is odynophagia?

A

pain when swallowing

27
Q

what causes odynophagia

A

Ulcers
Tumours
Fungal infection in immunocompromised

28
Q

A 66-year-old man presents to his GP with progressive dysphagia. Initially this was only with solid food, but lately he is having trouble swallowing even soup. Which of the following investigations is the gold standard?

A

Endoscopy

Case 19 Diseases of the Upper GI tract (2 decks)

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