Oesophageal cancer

Question 1

outline a typical presentation for oesophageal cancer?

Answer 1

progressive dysphagia

burning chest pain

FLAWS

new onset over 55 years is carcinoma unless proven otherwise

Question 2

define oesophageal cancer?

Answer 2

malignant tumour arising in the oesophgus-> 2 major histological types

• squamous cell carcinoma - middle 1/3
• adenocarcinoma - lower 1/3

Question 3

what are the risk factors for squamous cell carcinoma type of oesophageal cancer?

Answer 3

Alcohol

Smoking

Tumour

Plummer-Vinson syndrome - rare disease characterized by difficulty swallowing, iron-deficiency anemia, glossitis, cheilosis and esophageal webs.

Achalasia – lower sphincter fails to open during swallowing so a backup of food

Scleroderma

Coeliac disease

Nutritional deficiencies

Dietary toxins (e.g. nitrosamines – cured meats, pickles)

FH

Question 4

what are the risk factors for adenocarcinoma type of oesophageal cancer?

Answer 4

GORD

Barrett’s oesophagus

Hiatus hernia

Question 5

summarise the epidemiology of oesophageal cancer?

Answer 5

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 6

what are the presenting symptoms of oesophageal cancer?

Answer 6

Often ASYMPTOMATIC

Progressive dysphagia (initially worse for solids)

burning chest pain

Regurgitation

Cough – may indicate a oesophagotracheal or oesophagobronchial fitsula from local invasion by tumour

Choking after food

Voice hoarseness

Odynophagia (painful swallowing)

Weight loss

Hiccups if phrenic N is involved

Fatigue (due to iron deficiency anaemia)

Question 7

what are the signs of oesophageal cancer on physical examination?

Answer 7

There may be NO SIGNS

Metastatic disease may cause:

• Supraclavicular lymphadenopathy
• Hepatomegaly
• Hoarseness
• Signs of bronchopulmonary involvement

Question 8

what are the appropriate investigations for oesophageal cancer?

Answer 8

Oesophagogastroduodenoscopy (OGD) with biopsy –test patients with evere dysphagia, odynophagia, or weight loss

-> mucosal lesion; histology shows squamous carcinoma or adenocarcinoma

Comprehensive met profile should be performed in advanced cases with near or complete obstruction as they can become very volume depleted and hypokalaemic

CT/MRI or thorax and abdo to look at metastases