Oesophageal cancer

Question 1

Types

Answer 1

Squamous cell carcinoma in top third

Adenocarcinoma in lower 2/3rds

Question 2

Causes of squamous cell carcinoma

Answer 2

Smoking or alcohol

Processed red meats

Obesity

Achlasia

Plummervinson syndrome (oesophageal web, post-cricoid dysphagia and iron deficinecy anaemia [glossitis, angular stomatitis, pallor])

Question 3

Cause adenocarcinoma

Answer 3

GORD: oesophagitis to Barrett’s to adenocarcinoma

Question 4

Clinical features

Answer 4

Progressive dysphasia: solids affected first and then liquids

Voice hoarseness (if affecting upper 1/3rd of oesophagus [squamous cell carcinoma] due to compression of the recurrent laryngeal nerve)

Cough

Other red flags: 
weight loss
Anaemia 
Haematemesis / melaena 
Lymphadenopathy

Question 5

2 week wait indications

Answer 5

Dysphasia

Age 55 or over with weight loss and any of:

• upper abdo pain
• reflux
• dyspepsia

Question 6

Complications

Answer 6

Local: spread to laryngeal / phrenic nerve, airway etc.

Distant: metastasis to liver, DVT

Mortality

Question 7

Investigations

Answer 7

Bloods: FBC (iron deficient anaemia), LFTs, bone profile for metastasis

Imaging: gold standard - OGD endoscopy and biopsy
Barium swallow showing apple core stricture
CT for staging

Question 8

Management

Curative

Answer 8

MDT

Medical: neo adjuvant or adjuvant chemotherapy , radiotherapy

Surgical: oesophagectomy

Question 9

Management

Palliative

Answer 9

Conservative: palliative care team, MDT , Macmillan

Medical: analgesia, palliative chemo

Interventional: palliative radiotherapy (external or brachytherapy) e.g. stent