Oesophageal Cancer

Question 1

How common is oesophageal cancer.

Answer 1

It is the 6th most common cancer worldwide.

Question 2

Where does squamous cell oesophageal cancer. (2)

Answer 2

It occurs in the middle third of the oesophagus.

They also occur in the upper third.

Question 3

What percentage of oesophageal cancers are due to squamous cell cancers. (2)

Answer 3

50% of tumours occur in the middle third.

20% occur in the upper third.

Question 4

Where do adenocarcinomas tend to occur. (2)

Answer 4

In the lower third of the oesophagus.

At the cardia.

Question 5

What percentage of oesophageal tumours are due to adenocarcinomas.

Answer 5

30%.

Question 6

What are the types of oesophageal cancer. (3)

Answer 6

Squamous cell carcinoma.
Adenocarcinoma.
Primary cell cancer.

Question 7

What are the risk factors for squamous cell carcinoma of the oesophagus. (9)

Answer 7

Smoking. 
Alcohol. 
Plummer-Vinson syndrome. 
Achalasia. 
Corrosive strictures. 
Coeliac disease. 
Breast cancer treated with radiotherapy. 
Tylosis. 
Diets low in vitamin A and C. 
Nitrosamine exposure.

Question 8

What are the risk factors for adenocarcinoma of the oesophagus. (6)

Answer 8

Longstanding heartburn. 
Barrett's oesophagus. 
Smoking. 
Obesity. 
Breast cancer treated with radiotherapy. 
Older age.

Question 9

What geographic areas have high rates of oesophageal squamous cell carcinoma. (5)

Answer 9

Ethiopia.
China.
South and east Africa.
Caspian regions of Iran.

Question 10

What is the incidence of squamous cell carcinoma of the oesophagus in the UK.

Answer 10

5-10/100,000.

Question 11

What percentage of malignant disease is due to squamous cell carcinoma of the oesophagus in the UK.

Answer 11

2.2%.

Question 12

What is the male:female ratio of squamous cell carcinoma of the oesophagus.

Answer 12

2:1.

Question 13

What age group is most affected by oesophageal cancer.

Answer 13

60-70 years old.

Question 14

What are the clinical features of oesophageal cancer. (5)

Answer 14

Dysphagia (progressive, painless for solid foods then liquids).
Weight loss.
Retrosternal chest pain.
Signs from the upper third of the oesophagus:
Hoarseness.
Cough (may be paroxysmal if aspiration pneumonia).

Question 15

What are the three commonest physical signs of oesophageal cancer.

Answer 15

Weight loss.
Anorexia.
Lymphadenopathy.

Question 16

Why might strictures develop in oesophageal cancer.

Answer 16

The lesion itself may be ulcerative, proliferative or scirrhous, extending variably around the wall of the oesophagus to produce a stricture.

Question 17

What complication arises with the development of an oesophageal stricture.

Answer 17

Causes difficulty in swallowing saliva and coughing and aspiration into the lungs is common.

Question 18

Where does oesophageal cancer tend to metastasis to.

Answer 18

Usually to lymph nodes (commoner than distant metastases).

Question 19

What are the two diagnostic tests in oesophageal cancer. (2)

Answer 19

Endoscopy with biopsy.

Barium swallow.

Question 20

What is the overall male:female ratio of oesophageal cancer.

Answer 20

5:1.

Question 21

How are oesophageal cancers staged.

Answer 21

TNM staging system.

Question 22

What is the most common type of benign tumour of the oesophagus.

Answer 22

Leiomyoma.

Question 23

What are the complications of oesophageal tumours. (2)

Answer 23

Strictures.

Fistulae between the oesophagus and the trachea or bronchial tree.

Question 24

What are the clinical features of an oesophageal fistulae. (3)

Answer 24

Pleural effusions.
Pneumonia.
Coughing after swallowing.