Oesophageal cancer

Question 1

What is oesophageal cancer?

Answer 1

Oesophageal cancer = malignant tumour originating from the cells of the oesophagus

Question 2

What is the aetiology of oesophageal cancer?

Answer 2

Differs with histology

Adenocarcinoma (lower 1/3 oesophagus)
Barrett’s oesophagus - Pre-malignant metaplasia caused by long-standing GORD
Often detected adjacent to a tumour
Increased frequency/duration/severity positively associated with risk

Obesity - Not necessarily due to increase in GORD in obese patients

Diet - Each 50g of fruit and vegetables eaten per day decreases risk by 20%

Squamous cell carcinoma (upper 2/3 oesophagus)
Smoking - 3-7x increased risk with squamous cell carcinoma and 2x increase with adenocarcinoma
>1.5 bottles of wine and smoking 10-30 cigarettes daily has a 150x increased risk

Alcohol - Excess alcohol (>3 drinks a day) carries a 5x increased risk

Question 3

What are the risk factors for oesophageal cancer?

Answer 3

General -
Male (7x greater risk)
Low socioeconomic status
Low intake of fruit and vegetables

Adenocarcinoma -
GORD (and Barrett’s oesophagus)
Obesity
Hiatus hernia

Squamous - 
Smoking
Alcohol
Family history
Non-white
High temperature beverages
HPV
Achalasia

Question 4

What is the epidemiology of oesophageal cancer

Answer 4

Highest rates in Russia, Scotland and Scandinavia

Fastest rising incidence of any malignancy (particularly adenocarcinoma)

Black people and Far Eastern people at increased risk

More likely in men

13th most common cause of cancer in UK

8th most common cause of cancer death in UK (15% 5 year survival rate)

Adenocarcinoma more common that squamous in UK (but not worldwide)

Question 5

What are the symptoms of oesophageal cancer?

Answer 5

Dysphagia – progressive difficulty solids, then liquids

Odynophagia 
Weight loss (+ other FLAWS)

Dyspepsia

Anaemia

Hiccups - Phrenic nerve involvement

Postprandial cough - Oesophagotracheal fistula

Question 6

What are the signs of oesophageal cancer?

Answer 6

Hoarseness - Recurrent laryngeal involvement

Anaemia - Pallor, Koilonychia

Question 7

What are the appropriate investigations for oesophageal cancer?

Answer 7

Endoscopy – OGD with biopsy
Irregular mass
SCC - ulcerated

Bloods
Hypokalaemia
Elevated creatinine
Elevated urea

Other investigations - Staging
CT – Thorax and abdomen
Preferred
Poor detection for metastases

MRI – Thorax and abdomen

FDG-PET scan
Hyperactivity at primary tumour site
Lung/liver/bone metastases

Endoscopic ultrasound
Local/lymph node invasion