Oesophageal Cancer Flashcards
(36 cards)
What are the risk factors for oesophageal cancer?
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
Where are most oesophageal carcinomas?
20% upper
50% middle
30% lower
What is the histology of cancers of different parts of the oesophagus?
Proximal - squamous
Distal - adenocarcinoma
What are the symptoms shared by all the oesophageal cancers?
Weight loss
Dysphagia
Retrosternal chest pain
Which symptoms are only present in upper oesophageal cancer?
Hoarse voice
Cough
What are the differentials of oesophageal cancer?
Oesophagitis
Achalasia
Spasm
Stricture
What tests do we do?
Oesophagoscopy with biopsy
CT/MRI for staging
If significantly beneath the diaphragm then can do laparoscopy
What is the treatment of oesophageal cancer?
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
How many of those with Barrett’s oesophagus develop oesophageal cancer?
Relatively increases by 50 times
Still only 3 in 1000 though
What is the histological change in Barrett’s oesophagus?
Simple squamous epithelium to columnar epithelium
What is the definition of a malignancy?
Something that had invaded beyond the basement membrane
What is the name of the cell change in Barrett’s oesophagus?
Metaplasia
What is the Z line?
The normal line at the lower oesophagus between the simple squamous epithelium and the columnar epithelium at the lower oesophageal junction
What can the metaplastic process of Barrett’s oesophagus lead to?
Dysplasia, then malignant neoplasia
When do we 2 week wait people for endoscopy?
Those with
Dysphagia
OR
Over 55 with weight loss and any of reflux, upper abdo pain and dyspepsia
As part of referring someone for the two week wait, what follow up do you do?
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
What are some indications for non-urgent endoscopy for oeso ca?
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
How many people die each year in UK due to OCa?
6700
What type of cancers are the majority of OCa?
Squamous cell carcinoma
Adenocarcinoma
What are the most important factors that affect chances of OCa?
Alcohol
Smoking
What dietary factors are linked to oeso cancer?
Lack of fruit and veg Lack of dairy Lack of folate Pickles Low Vit A, C, riboflavin
Which gene increases chance of oeso Ca?
MTHFR C677T
If you have heartburn for, how does that affect your chance of oeso ca?
Once a week: 8 times
Nighttime: 11 time
How does your symptom score over 20 years affect your chance of oeso ca?
20 years of over 4.5 score increases chance by 43.5 times
