Oesophageal cancer Flashcards
Epithelium histology of oesophagus?
Squamous
Epithelium histology of stomach?
Columnar
What is Barrett’s oesophagus?
Reflux causing metaplasia/dysplasia/adenocarcinoma
caused by obesity induced hiatus hernia
What is achalasia of the cardia?
Failure of the oesophageal sphincter to relax such that food can’t get into the stomach
Types of oesophageal cancer?
Adenocarcinoma - lower oesophagus, from reflux
Squamous carcinoma - upper oesophagus, Asia
Symptoms of oesophageal cancer?
Dysphagia Persistent indigestion/heartburn Weight loss Pain in throat/behind sternum Persistent cough Regurgitation of food
Investigations?
Oesophago-gastric-duodenoscopy (OGD)
FBC, U+Es, LFTs
CT CAP
Stage 0 =
High grade dysplasia
Stage 1a =
Submucosa
Stage 1b =
Muscles
Stage 2a =
Outside serosa
Stage 2b =
Involves muscles and 1-2 lymph nodes
Stage 3a =
Involves pleura, pericardium or diaphragm
or involves serosa and 1-2 nearby lymph nodes
or involves muscles and 3-6 nearby lymph nodes
T4, N0, M0 =
Stage 3a
T3, N1, M0 =
Stage 3a
T1/2, N2, M0 =
Stage 3a
T3, N2, M0 =
Stage 3b
Stage 3c =
Involves 6 LNs, pleura, heart or diaphragm
or involves trachea, vertebra/aorta and LNs
or involves >7 LNs
T4a, N1/2, M0 =
Stage 3c
T4b, N1-2, M0 =
Stage 3c
T1-4, N3, M0 =
Stage 3c
Stage 4 =
Distant metastases e.g. liver or lung
M1
What surgical options are there?
Endoscopic mucosal resection (EMR) Endoscopic submucosal resection (ESD) Ivor-Lewis oesophago-gastrectomy Oesphagectomy Stenting of the oesophagus as palliative
2 drug chemo combo:
Cisplatin + fluorouracil (5FU)
Cisplatin + capecitabine (CX)
3 drug chemo combo:
Epirubicin + cisplatin + capecitabine (ECX)
Epirubicin + oxaloplatin + capecitabine (EOX)
Treatment for advanced cancer:
Herceptin in Her2 +ve
Epirabicin + cisplatin + fluorouracil (ECF)
Diagnosis?
Endoscopy
CT CAP/endoscopic US for staging
What is the Ivor-Lewis oesophagogastrectomy?
Removing lower third of oesophagus and upper stomach then mobilising the duodenum to join
