Oesophageal cancer Flashcards
Where do cancers of the oesophagus occur?
40% in the middle third (SCC)
45% in the lower third at the cardia (adenocarcinomas)
Upper third is rare
What are the risk factors for SCC of the oesophagus?
Smoking Heavy alcohol intake Plummer-Vinson syndrome Achalasia Coeliac disease Tylosis Diet deficient in vitamins
What are the risk factors for adenocarcinomas of the oesophagus?
Long standing GORD
Barrett’s oesophagus
Smoking
Upper GI symptoms that would indicate need for an endoscopy
ALARMS 55 Anaemia: Fe deficient Loss of weight Anorexia Recent onset, progressive symptoms Melaena/haematemeis Swallowing difficulties >55yo
Barratt’s oeosphagus pathophysiology
Affects 2% adults in the UK
Long-standing reflux: normal stratified squamous epithelium undergoes metaplasia –> glandular columnar epithelium
Continued inflammation: dysplasia & malignant change (adenocarcinoma of the lower 1/3 of the oesophagus)
Barratt’s oesophagus presentation & investigations
Symptom’s of GORD
Diagnosis: upper GI endoscopy + biopsy to confirm
Typical upper GI malignancy presentation
Short Hx of progressive dysphagia, severe weight loss, elderly
Plummer-Vinson syndrome presentation
Triad of: dysphagia, koilonycia, glossitis
Pre-malignant condition due to hyperkeratinisation of the oesophagus causing an oesophageal web
Symptoms suggestive of oesophageal malignancy
>60y Progressive dysphagia Weight loss & anorexia Retrosternal chest pain Coughing/aspiration Occasional lymphadenopathy
Adenocarcinoma of the oesophagus pathology
Most common oesophageal carcinoma
Arise from areas of metaplasia in the lower 1/3 (Barrett’s oesophagus)
Risk factors = GORD risk factors
Metastasise earlier than SCC via lymphatics: liver, lungs, bones
<10% 5y survival
Squamous cell carcinoma of the oesophagus pathology
Heavy smoking & drinking males
Present late: lumen compromised = dysphagia
Regional lymph spread: early & common
More responsive to radiotherapy
<10% 5y survival
