Oesophageal Cancer Flashcards
Pathology
SCC
Adenocarcinoma
Risk factors for SCCs
Smoking
Achalasia
Risk factors for adenocarcinoma
GORD
Barett’s oesophagus
Achalasia
Obesity
Presentation
Progressive dysphagia Weight loss Anorexia Odynophagia (painful swallowing) Hoarseness (recurrent laryngeal nerve invasion) Chest pain Resp Symptoms
Examination
Non-contributory for early disease Advanced disease: -cervical lymph nodes -weight loss -anaemia -hepatomegaly
Diangosis
Endoscopy + Biopsy
Staging
TMN
Management
Nutritional assessment
S:
- endoscopic mucosal resection for early oesophageal neoplasms
-Resectable tumours are T1b–T3 ± N1. T4 tumours invading the
diaphragm, pleura, or pericardium may also be considered candidates.
A/NA
- Cisplatin + fluorouracil/capecitabine for metastatic disease
Operation Specific Complications
Anastomotic leak
Treatment of dysphagia in palliative setting
Dilatation of the malignant stricture and stent insertion
Mrs Sarah Whiston is a 61 year old married secretary. She has a 6 month history of reflux and heartburn. Over the last few weeks she has found it more difficult to swallow certain foods. She has come to your clinic for further investigation.
Which investigation?
OGD
Investigations
First Line: upper GI endoscopy + biopsy
Barium studies in those who can’t tolerate endoscopy (but not really a great diagnostic tool for tumours)
Laparoscopy for distal tumours
Bone scan if patient complains of bone pain/hypercalcaemia
Mr Smith is found to have a tumour in his distal oesophagus, that invades the mucosa and some muscle. He is also found to have involvement of 9 of nearby lymph nodes. CT shows no metastases.
What is Mr Smith’s TMN and what stage of oesophageal cancer does he have?
T2, N3, M0
