Oesophageal Cancer

Question 1

What are risk factors for oesophageal cancer?

Answer 1

Smoking
Alcohol excess
GORD
Barrett’s oesophagus (stratified squamous to simple columnar with goblet cells)
Achalasia - failure of lower oesophageal sphincter to relax preventing food from entering stomach
Pulmmer Vinson syndorme

Question 2

Where does oesophageal cancer occur? What histology?

Answer 2

20% in upper part
50% in middle
30% in lower part

Squamous cell carcinoma - proximal (upper2/3)
Adenocarcinoma - distal - lower 1/3

Question 3

What are clinical features of oesophageal cancer?

Answer 3

Dysphagia
Anorexia
Weight loss
Vomiting
Odynophagia
Hoarseness
Meleana
Cough

Question 4

What is 2WW referral criteria?

Answer 4

> =55 with dysphagia, weight loss, mass

Question 5

What Ix in oesophageal cancer?

Answer 5

Upper GI endoscopy with biopsy
CT CAP for staging
Endoscopic US for local disease staging

Staging laparoscopy with peritoneal washings for peritoneal disease

Question 6

What staging in oesophagesal cancer? Spread via?

Answer 6

Direct, submucosal infiltration, local spread to nodes, later - blood

TNM
Tis - in situ
T1 - invading lamina propria
T2 - invading muscularis propria
T3 - adventitia
T4 - adjacent structures

Nx - nodes cannot be assessed
N0 - no node spread
N1-N£ - regional node metastases

M0 - no distant mets
M1 - distant mets

Question 7

What Mx in oesophageal cancer?

Answer 7

Surgical resection
Ivor Lewis radical oesphagectomy
Oesophageagastric anastomosis

Chemoradiothearpy

Question 8

Complications of surgical resection?

Answer 8

Anastamotic leak will result in mediastinitis due to intrathoracic anastamosis