Oesophageal cancer

Question 1

What are the 2 types of esophageal cancer?

Answer 1

Squamous carcinoma

Adenocarcinoma

Question 2

3 risk factors of squamous carcinoma?

Answer 2

Smoking
Alcohol
Dietary carcinogens

Question 3

2 risk factors of adenocarcinoma?

Answer 3

Barrett’s oesophagus

Obesity (Increased abdo pressure = inc chance of reflux)

Question 4

Describe Squamous carcinoma and its location?

Answer 4

Exophytic tumour

Proximal & middle third of oesophagus

Question 5

Location of adenocarcinoma?

Answer 5

Distal third esophagus

Question 6

3 local effects of esophageal cancer?

Answer 6

Obstruction
Ulceration
Perforation

Question 7

Describe 3 levels of spread of the tumour

Answer 7

Direct (surrounding tissue)
Lymphatic spread (regional lymph nodes)
Blood ( - liver)

Question 8

Prognosis of esophageal cancer

Answer 8

<15% 5 year survival

Question 9

6 warning signs of esophageal cancer

Answer 9

Frequent persistent hiccups
Acid indigestion, heartburn, reflux
Dysphagia
Constant burp, belch, cough
Pain between shoulder blades
Weight loss

Question 10

Why is it easier for esophageal tumour to invade into adjacent structures than some other tumours?

What effect does this have?

Answer 10

No peritoneal lining in mediastinum

Local invasion often limits surgery

Question 11

What is the upper GI ALARM acronym?

Answer 11

Anaemia
Loss of Weight
Anorexia
Recent onset or progressive
Mass and melaena/haematemesis
Swallowing difficulty

Question 12

When to do an upper GI endoscopy?

Answer 12

> 55 or ALARM symptoms

Question 13

7 symptoms of oesophageal cancer?

Answer 13

Progressive dysphagia
Anorexia
Weight loss
Chest pain
Pneumonia
Cough
Haematemesis

Question 14

What is haematemesis?

Answer 14

Vomiting blood

Question 15

2 signs of oesophageal cancer?

Answer 15

Pneumonia

Vocal cord paralysis

Question 16

Why is pneumonia a sign of oesophageal cancer?

Answer 16

Tracheo-oesophageal fistula

Question 17

What is a fistula?

Answer 17

Abnormal connection between 2 spaces or organs

Question 18

Investigations of oesophageal cancer?

Answer 18

Endoscopy
Biopsy
CT

Question 19

What staging is used?

Answer 19

TNM staging

Question 20

What 4 investigations are used to stage?

Answer 20

CT (chest, abdo, pelvis)
Endoscopic ultrasound
PET scan
Bone scan

Question 21

What are 2 common metastases of oesophageal cancer?

Answer 21

Lung

Liver

Question 22

In TNM staging what does T1 correlate to?

Answer 22

Tumour invades lamina propria or submucosa

Question 23

T2?

Answer 23

Invasion of muscularis propria

Question 24

T3?

Answer 24

Invades adventitia

Question 25

T4?

Answer 25

Invades adjacent structures

Question 26

In TNM staging what does N1 correlate to?

Answer 26

Regional lymph node metastasis

Question 27

M1?

Answer 27

Distant metastasis

Question 28

Treatment of oesophageal cancer to cure?

Answer 28

Surgical oesophagectomy +/- adjuvant or neoadjuvant chemotherapy

Question 29

What does adjuvant mean?

Answer 29

After initial treatment

Question 30

What does neoadjuvant mean?

Answer 30

First step treatment

Question 31

Criteria for surgical oesophagectomy? (3)

Answer 31

No localised disease
<70
No comorbidities

Question 32

Management for locally advanced inoperable disease?

Answer 32

Chemotherapy & radiotherapy to improve survival

Question 33

Palliative management of esophageal cancer? (4)

Answer 33

Endoscopic - stent (improve swallowing), PEG
Chemo
RT
Brachytherapy

Question 34

What is brachytherapy?

Answer 34

Places radioactive sources inside patient to kill cancer cells & shrink tumours

Question 35

What support is needed post oesophagectomy?

Answer 35

Nutritional support