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Z - Cancer Care Old > Oesophageal Cancer > Flashcards

Oesophageal Cancer Flashcards

1
Q

How common is oesophageal cancer in the UK, compared to other cancers?

A

It is the 9th most common cancer in the UK

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2
Q

Describe the age distribution of oesophageal cancer

A

There are very few cases below the age of 45, and the incidence increases eightfold between 45-54, and 65-74 years

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3
Q

Describe the gender distribution of oesophageal cancer

A

It has a sevenfold higher incidence in men than women

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4
Q

How much more common is oesophageal cancer in China compared to the UK?

A

20-30 times more common

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5
Q

What are the most common histological types of oesophageal cancers?

A
  • Adenocarcinoma

- Squamous cell carcinoma

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6
Q

What proportion of oesophageal cancers are adenocarcinomas?

A

1/3

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7
Q

Where are adenocarcinomas of the oesophagus found?

A

They are mostly found in the distal oesophagus

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8
Q

What proportion of oesophageal cancers are squamous cell carcinomas?

A

2/3

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9
Q

What % of oesophageal squamous cell carcinomas are found in the upper oesophagus?

A

15%

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10
Q

What % of oesophageal squamous cell carcinoma are found in the mid-oesophagus?

A

45%

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11
Q

What % of oesophageal squamous cell carcinomas are found in the lower oesophagus?

A

40%

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12
Q

What is squamous cell cancer of the oesophagus associated with?

A

Chronic irritation

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13
Q

What can cause chronic irritation of the oesophagus?

A
  • Alcohol
  • Caustic injury
  • Radiotherapy
  • Achalasia
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14
Q

What other conditions are associated with squamous cell cancers of the oesophagus?

A
  • Plummer-Vinson syndrome
  • Chronic iron deficiency
  • Dysphagia
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15
Q

What are the features of Plummer-Vinson syndrome?

A
  • Sideroblastic anaemia
  • Glossitis
  • Oesophagitis
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16
Q

In which population in particular do other conditions cause squamous cell cancers of the oesophagus?

A

Impoverished populations

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17
Q

What genetic trait carries an increased risk of squamous cell carcinomas of the oesophagus?

A

Hereditary tylosis

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18
Q

What is the inheritance pattern of hereditary tylosis?

A

Autosomal dominant

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19
Q

What does hereditary tylosis cause?

A

Palmar-plantar hyperkeratosis

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20
Q

What risk of squamous cell carcinoma of the oesophagus does hereditary tylosis carry?

A

95% risk by the age of 70

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21
Q

What is adenocarcinoma of the oesophagus associated with?

A
  • Gastro-oesophageal reflux
  • Hiatus hernia
  • Obesity
  • Frequent antacid or histamine H2 receptor blocker use
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22
Q

What % of patients with reflux does Barrett’s oesophagus develop in?

A

8%

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23
Q

What does Barrett’s oesophagus lead to?

A

Metaplasia of the normal squamous epithelium of the lower oesophagus to columnar epithelium, which may be dysplastic

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24
Q

What is the annual transformation of Barrett’s oesophagus to adenocarcinoma?

A

0.5%

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25
Q

What shift has there been in oesophageal cancer in recent years?

A

From squamous to adenocarcinoma

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26
Q

What does the shift from squamous to adenocarcinoma oesophageal cancers perhaps reflect?

A

Changing patterns of smoking, obesity, and nutrition of patients

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27
Q

What are the rare types of oesophageal cancer?

A
  • Small cell carcinoma
  • Mucoepidermoid carcinoma
  • Sarcoma
  • Adenoid cystic carcinoma
  • Primary lymphoma
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28
Q

What is the most common presenting complaint of oesophageal cancer?

A

Dysphagia

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29
Q

What might dysphagia be associated with in oesophageal cancer?

A
  • Weight loss

- Haematemesis

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30
Q

What are the features of the dysphagia in oesophageal cancer?

A
  • Can deteriorate rapidly over a period of weeks to months
  • Typically progressive in nature
  • Worse for solids than liquids
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31
Q

What are the other symptoms of oesophageal cancer?

A
  • Dyspepsia
  • Dyspnoea
  • Odynophagia
  • Iron deficiency anaemia
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32
Q

What level of weight loss is associated with a worse outcome in oesophageal cancer?

A

> 10% total body weight

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33
Q

What can be caused by invasion of oesophageal cancer into adjacent anatomical structures?

A

Oesophageal fistula

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34
Q

What can be caused by an oesophageal fistula?

A
  • Recurrent pneumonia

- Aspiration pneumonia

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35
Q

What are common features of oesophageal cancer that is advanced at presentation?

A
  • Left supraclavicular lymphadenopathy (Virchow’s node)
  • Hepatomegaly
  • Pleural effusion
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36
Q

What might happen if an oesophageal tumour invades the thoracic aorta?

A

Rapid exsanguination

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37
Q

Is involvement of the pericardium common in oesophageal cancer?

A

No, it is uncommon

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38
Q

What can involvement of the pericardium cause in oesophageal cancer?

A
  • Arrhythmias

- Pericardial effusion

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39
Q

What might hoarseness be a sign of in oesophageal cancer?

A

Phrenic nerve involvement

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40
Q

What might hiccups be a sign of in oesophageal cancer?

A

Phrenic nerve involvement

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41
Q

How can bone involvement in oesophageal cancer be identified?

A
  • Pain

- Hypercalcaemia

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42
Q

What should be looked for on examination of the face in oesophageal cancer?

A
  • Conjunctival pallor
  • Jaundice
  • Glossitis
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43
Q

What may glossitis be a sign of in oesophageal cancer?

A

Plummer-Vinson syndrome

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44
Q

What lymph nodes should be assessed in oesophageal cancer?

A
  • Neck (cervical)
  • Supraclavicular (Virchow’s)
  • Axillary
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45
Q

What symptoms should be asked about in oesophageal cancer?

A
  • Retrosternal pain

- Vomiting

46
Q

What should be looked for on examination of the hands in oesophageal cancer?

A
  • Pallor
  • Palmar hyperkeratosis
  • Kolinonychia
47
Q

What might palmar hyperkeratosis be a sign of in oesophageal cancer?

A

Hereditary tylosis

48
Q

What might koilionychia be a sign of in oesophageal cancer?

A

Plummer-Vinson syndrome

49
Q

What should be looked for on peripheral examination in oesophageal cancer?

A

Plantar hyperkeratosis

50
Q

What may plantar hyperkeratosis be a sign of in oesophageal cancer?

A

Hereditary tylosis

51
Q

What should be looked for on cardiovascular examination in oesophageal cancer?

A
  • Atrial fibillation

- Pericardial effusion

52
Q

What should be looked for on respiratory examination in oesophageal cancer?

A
  • Hoarseness
  • Hiccups
  • Aspiration pneumonia
  • Pleural effusion
  • Signs of infection, e.g. productive cough, fever, rigors
53
Q

What should be looked for on abdominal examination in oesophageal cancer?

A
  • Epigastric pain
  • Mass in epigastrum
  • Abdominal distention
  • Ascites
  • Hepatomegaly
  • Splenomegaly
  • Features of chronic liver disease
54
Q

What should be looked for on neurological examination in oesophageal cancer?

A

Confusion

55
Q

What should be looked for on observation in oesophageal cancer?

A
  • Dyspnoea
  • Cachexia
  • Dehydration
  • Dysphagia
  • Odynophagia
  • Dyspepsia
  • Anorexia
56
Q

How is a diagnosis of oesophageal cancer usually diagnosed?

A

Upper GI endoscopy and biopsy

57
Q

What is an alternative investigation for patients that cannot tolerate upper GI endoscopy in oesophageal cancer?

A

Barium studies

58
Q

What is the problem with barium studies in oesophageal cancer?

A

Cannot do biopsy

59
Q

When might laparoscopy be useful in oesophageal cancer?

A

For distal tumours

60
Q

What is the advantage of endoscopic ultrasound in oesophageal cancer?

A

It is very accurate in determining the depth of invasion

61
Q

What is the disadvantage of endoscopic ultrasound in oesophageal cancer?

A

It is less accurate in determining nodal involvement

62
Q

What CT imaging is required in oesophageal cancer?

A

Of the chest, abdomen, and pelvis

63
Q

What is CT imaging required for in oesophageal cancer?

A
  • Staging the disease

- Determining extent of spread and involvement of lymph nodes

64
Q

What is PET-CT used for in oesophageal cancer?

A

Increasingly being used before surgery to determine the extent of disease and operability

65
Q

What might bronchoscopy be required for in oesophageal cancer?

A

To detect tracheal invasion

66
Q

When should bone scan imaging be done in oesophageal cancer?

A

If the patient complaints of bone pain or has hypercalcaemia at presentation

67
Q

What is the treatment of choice for early stage oesophageal cancer?

A

Surgical resection, sometimes with neoadjuvant chemotherapy or chemoradiation

68
Q

What agents are used for neoadjuvant chemotherapy in early stage oesophageal cancer?

A
  • Cisplatin, carboplatin, or oxaliplatin
  • Fluorouracil
  • Epirubicin
69
Q

What is the problem with surgery in oesophageal cancer?

A

Many patients have precluding surgical co-morbidities such that <40% of patients are suitable for resection with oesophagectomy

70
Q

What is the operative mortality of surgery for oesophageal cancer?

A

5-10%

71
Q

What are the complications of surgery for oesophageal cancer?

A
  • Anastomotic leakage
  • Strictures
  • Reflux
  • Motility problems
72
Q

How good is adjuvant chemotherapy for oesophageal cancer?

A

The role and benefit of adjuvant chemotherapy is unclear

73
Q

What % of oesophageal cancer patients have advanced disease at diagnosis?

A

25%

74
Q

What might those with small volume inoperable oesophageal cancer be considered for?

A

Chemoradiation with curative intent

75
Q

What are the risks of chemoradiation with curative intent for oesophageal cancer?

A
  • Oesophageal perforation or stricture
  • Pneumonitis
  • Pulmonary fibrosis
76
Q

How are the majority of patients with locally advanced oesophageal cancer treated?

A
  • Stent insertion

- Palliative radiotherapy

77
Q

What is the point of stent insertion for locally advanced oesophageal cancer?

A

Manage dysphagia

78
Q

What is the point of palliative radiotherapy for locally advanced oesophageal cancer?

A

Manage pain or bleeding

79
Q

What % of patients with oesophageal cancer present with metastatic disease?

A

35%

80
Q

How are patients with metastatic oesophageal cancer treated?

A

Symptomatically, or with palliative combination chemotherapy if sufficiently fit

81
Q

What might some patients with metastatic oesophageal cancer be considered for?

A

Palliative radiotherapy with brachytherapy

82
Q

What can restore the oesophageal lumen and relieve dysphagia in oesophageal cancer?

A

Laser treatment and stent insertion

83
Q

What does the survival of oesophageal cancer correlate with?

A

Stage at presentation

84
Q

What is the 5 year survival for patients with in situ oesophageal cancer?

A

> 95%

85
Q

What is the 5 year survival for patients with local oesophageal cancer?

A

30-80%

86
Q

What is the 5 year survival for patients with oesophageal cancer with nodal involvement at presentation?

A

10-30%

87
Q

What is the 5 year survival rate for patients with metastatic oesophageal cancer?

A

<2%

88
Q

What % of patients with oesophageal cancer are suitable for surgical resection?

A

Approx 25%

89
Q

What is the 5 year survival rate of patients with oesophageal cancer that are suitable for surgical resection?

A

25%

90
Q

What is the overall 5 year survival of oesophageal cancer in the UK?

A

8%

91
Q

What could half of all oesophageal cancer be prevented by?

A

Education about;

  • Smoking cessation
  • Drinking less alcohol
  • Improving diet with more fresh fruit and vegetables
  • Reducing poorly preserved and high salt foods
92
Q

What is required for patients with Barrett’s oesophagus?

A

Endoscopic surveillance every 2-5 years

93
Q

What management is required for low-grade oesophageal dysplasia?

A

PPI therapy

94
Q

What management is required for high-grade oesophageal dysplasia?

A

Surgical resection

95
Q

What is Tx in oesophageal cancer?

A

The primary tumour cannot be evaluated

96
Q

What is T0 in oesophageal cancer?

A

There is no evidence of a primary tumour in the oesophagus

97
Q

What is Tis in oesophageal cancer?

A

Carcinoma in situ

98
Q

What is T1 in oesophageal cancer?

A

Tumour invading into the lamina propria/submucosa

99
Q

What is T2 in oesophageal cancer?

A

Tumour invading into the muscularis propria

100
Q

What is T3 in oesophageal cancer?

A

Tumour has penetrated into the adventitia

101
Q

What is T4a in oesophageal cancer?

A

Tumour has invaded into the pleura, the pericardium, or the diaphragm

102
Q

What is T4b in oesophageal cancer?

A

Tumour has spread into other nearby structures, such as the trachea, vertebrae, or the aorta

103
Q

What is Nx in oesophageal cancer?

A

Regional lymph nodes cannot be evaluated

104
Q

What is N0 in oesophageal cancer?

A

No regional lymphadenopathy

105
Q

What is N1 in oesophageal cancer?

A

Regional lymph node involvement (one or two lymph nodes)

106
Q

What is N2 in oesophageal cancer?

A

Regional lymph node involvement (three to six lymph nodes)

107
Q

What is N3 in oesophageal cancer?

A

Regional lymph node involvement (seven or more lymph nodes)

108
Q

What is Mx in oesophageal cancer?

A

Distant metastasis cannot be evaluated

109
Q

What is M0 in oesophageal cancer?

A

No distant metastasis

110
Q

What is M1 in oesophageal cancer?

A

Distant metastasis

Z - Cancer Care Old (28 decks)

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