Oesophageal Cancer Flashcards
Define oesophageal cancer
Malignant tumour arising in the oesophageal mucosa
The two major histological types are:
- Squamous cell carcinoma (cancer of squamous cells, usually occurs in upper 2/3rd of oesophagus)
- Adenocarcinoma (cancer of glandular tissue, usually occurs in the lower third of the oesophagus)
What is the aetiology of oesophageal cancer?
SQUAMOUS CELL CARCINOMA:
- Smoking
- Alchohol
- Achalasia
(loss of peristalsis → food stasis → chronic inflammation → predisposes to dysplasia and hence cancer)
- Paterson-Kelly syndrome
(triad of dysphagia, upper esophageal webs, and iron deficiency anemia)
- Tylosis
(rare autosomal dominant disease associated with hyperkeratosis of the palms and soles)
ADENOCARCINOMA:
- GORD → Barrett’s oesophagus
- Obesity
What are the risk factors for oesophageal cancer?
Main:
- Male
- Smoking
- Alcohol
- GORD and Barrett’s oesophagus
Others:
- Achalasia
- Paterson-Kelly syndrome
- Tylosis
- Obesity
What is the epidemiology of oesophageal cancer?
- Relatively common malignancy
- Affects males more
- Squamous cell carcinoma more common worldwide
- Adenocarcinoma more common in westernised countries
- Peak incidence: 60–70 years
What are the presenting symptoms of oesophageal cancer?
Often ASYMPTOMATIC in the early stages because the lumen of the oesophagus needs to be significantly reduced for symptoms to arise
Later stages:
- Dysphagia: initially with solids, then progressing onto liquids
- Odonophagia (painful swallowing)
- Weight loss
- Retrosternal pain
- Coughing after food
- Voice hoarseness (less common - due to infiltration of the recurrent laryngeal nerve)
What are the presenting signs of oesophageal cancer?
- Weight loss (loose clothes)
Signs of chronic GI bleeding:
- Anaemia (e.g. pallor)
- Melaena
Signs of metastasis:
- Supraclavicular lymphadenopathy
- Hepatomegaly
- Respiratory signs due to tracheobronchial involvement
Respiratory signs can also be due to aspiration (due to oesophageal obstruction)
What investigations would you do if you were suspecting oesophageal cancer and what would you expect to see??
- OGD with biopsy - 1st line (diagnostic - biopsy allows grading)
- Barium swallow
(useful for detecting strictures and intraluminal masses but does not allow biopsy)
To determine staging (how far the cancer has spread):
- CT: chest, abdomen and pelvis
- PET scan (can detect previously occult distant metastases)
Others:
- Bronchoscopy (if the oesophageal tumour is at or above the carina - risk of tracheobronchial invasion)
- Bone scan (if symptoms of bony involvement)
What is the management for oesophageal cancer?
This depends on the STAGE of the cancer and the decision should be reviewed in a MDT meeting
For earlier stages - curative:
- Surgery
- Chemotherapy
- Radiotherapy
For later stages - palliative:
- Most patients present in this stage
- Focus is on symptomatic relief