Oesophageal cancer Flashcards
What are the 2 types of esophageal cancer?
Squamous carcinoma
Adenocarcinoma
3 risk factors of squamous carcinoma?
Smoking
Alcohol
Dietary carcinogens
2 risk factors of adenocarcinoma?
Barrett’s oesophagus
Obesity (Increased abdo pressure = inc chance of reflux)
Describe Squamous carcinoma and its location?
Exophytic tumour
Proximal & middle third of oesophagus
Location of adenocarcinoma?
Distal third esophagus
3 local effects of esophageal cancer?
Obstruction
Ulceration
Perforation
Describe 3 levels of spread of the tumour
Direct (surrounding tissue)
Lymphatic spread (regional lymph nodes)
Blood ( - liver)
Prognosis of esophageal cancer
<15% 5 year survival
6 warning signs of esophageal cancer
Frequent persistent hiccups Acid indigestion, heartburn, reflux Dysphagia Constant burp, belch, cough Pain between shoulder blades Weight loss
Why is it easier for esophageal tumour to invade into adjacent structures than some other tumours?
What effect does this have?
No peritoneal lining in mediastinum
Local invasion often limits surgery
What is the upper GI ALARM acronym?
Anaemia Loss of Weight Anorexia Recent onset or progressive Mass and melaena/haematemesis Swallowing difficulty
When to do an upper GI endoscopy?
> 55 or ALARM symptoms
7 symptoms of oesophageal cancer?
Progressive dysphagia Anorexia Weight loss Chest pain Pneumonia Cough Haematemesis
What is haematemesis?
Vomiting blood
2 signs of oesophageal cancer?
Pneumonia
Vocal cord paralysis
Why is pneumonia a sign of oesophageal cancer?
Tracheo-oesophageal fistula
What is a fistula?
Abnormal connection between 2 spaces or organs
Investigations of oesophageal cancer?
Endoscopy
Biopsy
CT
What staging is used?
TNM staging
What 4 investigations are used to stage?
CT (chest, abdo, pelvis)
Endoscopic ultrasound
PET scan
Bone scan
What are 2 common metastases of oesophageal cancer?
Lung
Liver
In TNM staging what does T1 correlate to?
Tumour invades lamina propria or submucosa
T2?
Invasion of muscularis propria
T3?
Invades adventitia
T4?
Invades adjacent structures
In TNM staging what does N1 correlate to?
Regional lymph node metastasis
M1?
Distant metastasis
Treatment of oesophageal cancer to cure?
Surgical oesophagectomy +/- adjuvant or neoadjuvant chemotherapy
What does adjuvant mean?
After initial treatment
What does neoadjuvant mean?
First step treatment
Criteria for surgical oesophagectomy? (3)
No localised disease
<70
No comorbidities
Management for locally advanced inoperable disease?
Chemotherapy & radiotherapy to improve survival
Palliative management of esophageal cancer? (4)
Endoscopic - stent (improve swallowing), PEG
Chemo
RT
Brachytherapy
What is brachytherapy?
Places radioactive sources inside patient to kill cancer cells & shrink tumours
What support is needed post oesophagectomy?
Nutritional support
