Oesophageal Cancer Flashcards
What are the two main types of oesophageal cancer
SCC - more common in the developing world
Adenocarcinoma - more common in the developing world
What is SCC of the oesophagus associated with
- Excess alcohol consumption
- Smoking
- Chronic achalasia
- Low vit A levels
What is adenocarcinoma associated with
Long standing GORD
Obesity
High fat intake
Which part of the oesophagus does SCC most commonly affect
Upper 2/3rds
Which part of the oesophagus does adenocarcinoma affect
Lower 1/3rd
What are 3 rare type of oesophageal malignancies
Rhabdomyosarcoma
Leimyosarcoma, lymphoma
What are the clinical features of oesophageal cancer
Dysphagia - of solids more than liquids
Significant weight loss
Odynophagia/hoarseness
What may you find on clinical examination of someone with a GI malignancy
- Cachexia
- Virchows node enlargement
- signs of metastatic disease - hepatomegaly
What are the differential diagnosis of dysphagia
Intra luminal
- cancer
- foreign body
Extra luminal
- lymphadenopathy
Intra mural
- cancer
Motility disorders
-achalasia
- spasms
MG
What is the initial management of a patient with suspected Oesophageal malignancy
OGD in 2 weeks
Biopsy if mass is seen
If not fit for OGD - CT scan required
How would you further investigate Oesophageal cancer
If mass found on OGD, this will need to be staged using the following:
- CT chest-abdo-pelvis
- PET scan
- EUS to measure penetration of cancer in to the wall of the mucosa
- Staging laparoscopy
What is the curative management of SCC of oesophagus
Upper SCC => chemo radiotherapy ( CRT)
Middle and lower SCC => definitive CRT or Neoadjuvant CRT with surgery
What is the curative treatment for adenocarcinoma
Neoadjuvant chemo/CRT with oesophageal resection
What is the most common surgical management used to treat oesophageal carcinoma
- Ivor-Lewis oesophagectomy
What are the main complications of oesophagectomy
- Anastomosis leak
- Pneumonia
- Death
- Re-operation
