Oesophageal Cancer

Question 1

Definition

Answer 1

Malignant tumour arising in the oesophagus

There are TWO major histological types:
o Squamous cell carcinoma
o Adenocarcinoma

Question 2

Aetiology/risk factors (squamous cell carcinoma)

Answer 2

o Alcohol
o Tumour
o Plummer-Vinson syndrome
o Achalasia
o Scleroderma
o Coeliac disease
o Nutritional deficiencies
o Dietary toxins (e.g. nitrosamines)

Question 3

Aetiology/risk factors (adenocarcinoma)

Answer 3

o GORD

o Barrett’s oesophagus

Question 4

Epidemiology

Answer 4

· 8th most common cancer
· 3 x more common in MALES
· Squamous cell carcinoma is more common in DEVELOPING COUNTRIES
· Adenocarcinoma is more prevalent in the WESTERN WORLD

Question 5

Presenting symptoms

Answer 5

· Often ASYMPTOMATIC
· Progressive dysphagia (initially worse for solids)
· Regurgitation
· Cough
· Choking after food
· Voice hoarseness
· Odynophagia (painful swallowing)
· Weight loss
· Fatigue (due to iron deficiency anaemia)

Question 6

Signs on physical examination

Answer 6

· There may be NO SIGNS

· Metastatic disease may cause:
o Supraclavicular lymphadenopathy
o Hepatomegaly
o Hoarseness
o Signs of bronchopulmonary involvement

Question 7

Investigations

Answer 7

· Endoscopy - brushings and biopsy

· Imaging - barium swallow and CXR

· Staging - CT chest and abdomen

· Other - bronchoscopy, lung function tests and ABGs