Oesophageal cancer

Question 1

Two forms of oesophageal cancer

Answer 1

1. Squamous cell → middle third of the oesophagus
2. Adenocarcinoma → lower third of the oesophagus

Question 2

Risks factors for squamous cell oesophageal cancer

Answer 2

• smoking
• excess alcohol intake
• pre-existing oesophageal disease e.g. achalasia, stricture
• Coeliac’s disease

Question 3

Clinical features of oesophageal cancer

Answer 3

• progressive dysphagia (initially solids then liquids)
• weight loss
• possible chest pain (from a solid food impaction)

Question 4

Investigations for oesophageal cancer

Answer 4

Ix → to confirm the diagnosis and stage the tumour (TNM)

• gastroscopy
• tumour biopsy
• barium swallow →strictured area (but no biopsy can be taken)
• CT chest and abdomen → to look for metastases

Question 5

Types of groups of patients with oesophageal cancer (3)

Answer 5

• potentially curable early- stage disease
• unresectable disease
• distal metastases

Question 6

Management options for oesophageal cancer (3)

Answer 6

• surgery → performed if a tumour hasn’t infiltrate outside of the oesophagus (combined with pre-operative chemotherapy or radiotherapy)
• combined radiotherapy and chemotherapy → for patients with unresectable disease (to prolong survival and limit disease progression)
• chemotherapy and endoscopic stenting, laser or alcohol injection into the tumour→ to relieve symptoms, shrink the tumour

Question 7

Prognosis of oesophageal cancer

Answer 7

Poor

10% of 5 years survival