Oesophageal Cancer

Question 1

Description: How common is oesophageal cancer?

Answer 1

3rd most common cancer of the alimentary tract, 5th in world Cancer Mortality Rank

Question 2

Risk factors: In oesophageal cancer what are the risk factors for:

(a) Squamous cell carcinoma
(b) Adenocarcinoma

Answer 2

(a) Squamous cell carcinoma:
- Smoking
- Alcohol
- Dietary carcinogens

(b) Adenocarcinoma:
- Barrett’s Oesophagus
- Obesity
- Male sex
- Middle aged
- Caucasian

Question 3

Pathology: State the local effects of oesophageal cancer (3)

Answer 3

• Obstruction
• Ulceration
• Perforation

Question 4

Pathology: State the methods of spread of oesophageal cancer (3)

Answer 4

• Direct
• Lymphatic
• Blood

Question 5

Pathology: State the sites of metastasis for oesophageal cancer (4)

Answer 5

• Liver
• Lungs
• Brain
• Bone

Question 6

Pathology: Oesophageal cancer leads to local invasion of what structures? (3)

Answer 6

• Heart
• Aorta
• Trachea
  (limits surgery)

Question 7

Symptoms: State the symptoms of oesophageal cancer

Answer 7

• Progressive dysphagia
• Weight loss/anorexia
• Odynophagia
• Vocal cord paralysis
• Haematemesis
• Pneumonia (trachea-oesophageal fistula)
• Chest pain (retrosternal)
• Cough

Question 8

THE SIGNS WERE NOT IN THE LECTURE

Answer 8

THE SIGNS WERE NOT IN THE LECTURE

Question 9

Investigations: What investigations are done for oesophageal cancer to

(a) Confirm the diagnosis
(b) Stage the cancer

(c) Disease staging done by what classification?

Answer 9

(a) Confirm the diagnosis
- Endoscopy
- Biopsy

(b) To stage the cancer
- CT scan
- Endoscopic ultrasound
- PET scan
- Bone scan

(c) TNM

Question 10

Treatment: How do we treat oesophageal cancer?

Answer 10

CURABLE:
- Surgical oesophagectomy (to remove oesophagus) +/- adjuvant (after) or neoadjuvant (before) chemotherapy

INCURABLE
- Combined chemotherapy and radiotherapy (for improved long term survival)

• Symptom palliation/improves survival: Chemotherapy, radiotherapy, endoscopic stenting and brachytherapy
• Patients require nutritional support

Question 11

Complications: Complications for oesophageal cancer?

Answer 11

Probs death

Question 12

Extra: What are the two histological types of oesophageal cancer and in what regions of the oesophagus is affected for each type?

Answer 12

• Squamous cell carcinoma: Proximal and middle third
• Adenocarcinoma:
  Distal

Question 13

Extra: Prognosis for oesophageal cancer is good/bad

Answer 13

Bad

Question 14

Extra: Benign tumours for oesophageal cancer is common/rare

Answer 14

Rare

Question 15

Extra: Oesophageal cancer normally presents early/late

Answer 15

Late (cancer would have already spread to the sites of metastasis)

Question 16

Extra: For the treatment of oesophageal cancer, what type of patients is surgical oesophagectomy limited to? (3)

Answer 16

• Patients with localised disease
• Patients without co-morbid disease
• Patients < 70 years old