Oesophageal cancer Flashcards
What is oesophageal cancer?
Most oesophageal cancers are mucosal lesions but originate in the epithelial cells lining the oesophagus.
What are the two main histological types of oesophageal cancer?
Squamous cell carcinoma
Adenocarcinoma
Aetiology of oesophageal cancer
Important factors implicated in the development of oesophageal adenocarcinoma include:
- GORD and Barrett’s oesophagus
-High BMI
-Male sex
- Diets high in total fat and saturated fat
Important factors implicated in the development of oesophageal squamous cell carcinoma include:
- Tobacco smoking
- Alcohol consumption
-HPV
Pathophysiology of oesophageal cancer
- It arises in the mucosa and it progresses locally to invade the submucosa and muscular layer.
- It may invade contiguous structures such as the tracheobronchial tree, aorta, recurrent laryngeal nerve
- Metastasis typically occurs to the peri-oesophageal lymph nodes, liver and lungs.
Signs and symptoms of oesophageal cancer
Dysphagia (odynophagia) Weight loss Hoarseness Hiccups (uncommon) Post-prandial/ paroxysmal cough (uncommon)
Risk factors of oesophageal cancer
Male sex Tobacco use Alcohol use GORD and Barrett's oesophagus Hiatus hernia FHx of the oesophageal, stomach, oral or pharyngeal cancer
Investigations for the diagnosis of oesophageal cancer
OGD with biopsy
Comprehensive metabolic profile ( advanced cases- hypokalaemia)
Differentials of oesophageal cancer
Benign stricture
Achalasia
Barrett’s oesophagus
Management of oesophageal cancer
TNM staging important using CT Stage 0 and 1a: Endoscopic resection with or without ablation Stage 1, 2and 3: Oesophagectomy (1st line) Chemo/radiotherapy (2nd line) Stage 4: Chemotherapy