OESOPHAGEAL CANCER

Question 1

WHAT ARE THE 2 TYPES OF OESOPHAGEAL CANCER?

Answer 1

1) Squamous cell carcinoma

2) Adenocarcinoma

Question 2

WHICH REGION OF THE OESOPHAGUS DOES SQUAMOUS CELL CARCINOMA AFFECT AND WHAT IS ITS CAUSE?

Answer 2

• upper 1/3rd to middle of oesophagus

- smoking and excessive alcohol consumption

Question 3

WHICH REGION OF THE OESOPHAGUS DOES ADENOCARCINOMA AFFECT AND WHAT CAUSES IT?

Answer 3

• lower 1/3rd of oesophagus

- Barrett’s oesophagus (metaplasia to dysplasia to malignancy), long standing GORD, obesity and high dietary fat

Question 4

WHAT ARE THE CLINICAL FEATURES OF OESOPHAGEAL CANCER?

Answer 4

1) dysphagia - progressive, initially solids to liquids, any patients with dysphagia should be assumed to have oesophageal cancer until proven otherwise
2) significant weight loss
3) odonyphagia or hoarseness

Question 5

WHAT ARE THE RED FLAGS FOR UPPER GI MALIGNANCY?

Answer 5

• dysphagia

- over 55 yo with weight loss, upper abdominal pain, dyspepsia or reflux

Question 6

WHAT ARE THE SIGNS FOUND ON CLINICAL EXAMINATION?

Answer 6

• dehydration
• supraclavicular lymphadenopathy
• signs of metastatic disease - jaundice, hepatomegaly, ascites

Question 7

HOW DO YOU MANAGE A PATIENT WITH RED FLAG SYMPTOMS?

Answer 7

• urgent OGD with biopsy within 2 weeks

Question 8

WHAT ARE THE STAGING INVESTIGATIONS FOR OESOPHAGEAL CANCER?

Answer 8

1) CT chest-abdomen-pelvis and PET-CT together for distant metastases
2) Endoscopic US to measure T stage (penetration into oesophageal wall)
3) Staging laparoscopy
4) Palpable cervical lymph node investigated with fine needle aspiration

Question 9

WHAT IS THE PALLAITIVE MANAGEMNT (UNFIT FOR CURATIVE SURGERY) FOR OESOPHAGEAL CANCER?

Answer 9

1) Oesophageal stent - difficulty swallowing
2) Radiotherapy +/- chemotherapy to reduce tumour size and bleeding to temporarily improve symptoms
3) Nutritional support - thickened fluid and nutritional supplements due to significant dysphagia

Question 10

WHAT STAGING SYSTEM IS USED FOR OESOPHAGEAL CANCER?

Answer 10

TNM staging

Question 11

WHAT IS THE CURATIVE MANAGEMENT FOR OESOPHGEAL CANCER?

Answer 11

Neoadjuvant chemotherapy or chemo-radiotherapy followed by oesophageal resection (oesophagectomy)

Question 12

WHAT IS AN OESOPHAGECTOMY?

Answer 12

Removal of tumour, top of stomach and surrounding lymph nodes. Stomach made into tube and brought up into chest to replace oesophagus.