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Gastroenterology > Oesophageal Cancer > Flashcards

Oesophageal Cancer Flashcards

1
Q

What are the risk factors for oesophageal cancer?

A 
Bad diet 
Alcohol excess
Smoking
Achalasia
Reflux
Barrett's oesophagus
Obesity
Hot drinks
Men (x5)

Iron deficiency anaemia - Paterson-Brown-Kelly syndrome (high up tumour)
Nitrosamine exposure
Plummer-Vinson syndrome

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2
Q

Where are most oesophageal carcinomas?

A

20% upper
50% middle
30% lower

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3
Q

What is the histology of cancers of different parts of the oesophagus?

A

Proximal - squamous

Distal - adenocarcinoma

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4
Q

What are the symptoms shared by all the oesophageal cancers?

A

Weight loss
Dysphagia
Retrosternal chest pain

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5
Q

Which symptoms are only present in upper oesophageal cancer?

A

Hoarse voice

Cough

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6
Q

What are the differentials of oesophageal cancer?

A

Oesophagitis
Achalasia
Spasm
Stricture

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7
Q

What tests do we do?

A

Oesophagoscopy with biopsy
CT/MRI for staging

If significantly beneath the diaphragm then can do laparoscopy

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8
Q

What is the treatment of oesophageal cancer?

A

Pre-op chemo (fluorouracil and cisplatin) followed by radical curative oesophagectomy for localised T1/2 disease

Palliation (chemo/radio/stenting/laser) in advanced disease aims to restore swallowing with chemo/radiotherapy

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9
Q

How many of those with Barrett’s oesophagus develop oesophageal cancer?

A

Relatively increases by 50 times

Still only 3 in 1000 though

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10
Q

What is the histological change in Barrett’s oesophagus?

A

Simple squamous epithelium to columnar epithelium

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11
Q

What is the definition of a malignancy?

A

Something that had invaded beyond the basement membrane

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12
Q

What is the name of the cell change in Barrett’s oesophagus?

A

Metaplasia

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13
Q

What is the Z line?

A

The normal line at the lower oesophagus between the simple squamous epithelium and the columnar epithelium at the lower oesophageal junction

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14
Q

What can the metaplastic process of Barrett’s oesophagus lead to?

A

Dysplasia, then malignant neoplasia

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15
Q

When do we 2 week wait people for endoscopy?

A

Those with
Dysphagia
OR
Over 55 with weight loss and any of reflux, upper abdo pain and dyspepsia

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16
Q

As part of referring someone for the two week wait, what follow up do you do?

A

Since you are the referring doctor you need to take responsibility for acting on the result of the endoscopy. You will need a follow up appointment with the patient, even though in reality, the hospital team will most likely carry on his care

17
Q

What are some indications for non-urgent endoscopy for oeso ca?

A

Haematemesis

Over 55 with:
Treatment resistant dyspepsia
OR

Upper abdo pain and low Hb
OR

Raised Plt with 
N/V
W/L
Reflux
Dyspepsia
UAP
OR
N/V with
W/L
Reflux
Dyspepsia
UAP
18
Q

How many people die each year in UK due to OCa?

A

6700

19
Q

What type of cancers are the majority of OCa?

A

Squamous cell carcinoma

Adenocarcinoma

20
Q

What are the most important factors that affect chances of OCa?

A

Alcohol

Smoking

21
Q

What dietary factors are linked to oeso cancer?

A 
Lack of fruit and veg
Lack of dairy
Lack of folate
Pickles
Low Vit A, C, riboflavin
22
Q

Which gene increases chance of oeso Ca?

A

MTHFR C677T

23
Q

If you have heartburn for, how does that affect your chance of oeso ca?

A

Once a week: 8 times

Nighttime: 11 time

24
Q

How does your symptom score over 20 years affect your chance of oeso ca?

A

20 years of over 4.5 score increases chance by 43.5 times

25
Q

Can PPIs protect from adenocarcinoma?

A

no

26
Q

When would you refer with dyspepsia on 2WW?

A

Weight loss
Anaemia
Anorexia

Over 55 with one of

  • onset less than 1 yr
  • FH with Amsterdam rule (321)
  • Barrett’s oeso
27
Q

What is the amsterdam rule?

A

321
3 relatives
2 immediate
1 under 50

28
Q

What investigations do we do for OC?

A 
OGD -biopsy
Bloods
CT TAP - staging
EUS - staging
PET - mets
Laparoscopy
CPx - fitness level prior to treatment
29
Q

How do we treat T4/nodal oeso cancer?

A

Palliative treatment

30
Q

How do we treat potentially resectable patients?

A

Endoscopic USS

T1/2 N0 then immediate surgery

T3 N0 or T1/2 N1 with chemo then surgery

31
Q

WhWhen would we use radiotherapy?

A

In SCC

32
Q

What is the palliative care?

A

Can do chemo
Nutritional support (Stent, PEG, PEJ, jejunal feeding, surgical bypass, PN)
Pain control
Antiemetic

33
Q

What do we sort (treatment wise) before any definitive treatment?

A

Nutritional support:
Stent
NG tube
Parental nutrition

34
Q

Why is it so important to provide nutritional support?

A

So that the patient will be healthy enough both to go through treatment and survive

35
Q

Who do you ask with help for nutritional support?

A

Dietitian

36
Q

How many people are diagnosed early enough for operation?

A

25%

Gastroenterology (18 decks)

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