Oesophageal Cancer Flashcards

1
Q

Define oesophageal cancer

A

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)
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2
Q

What is the aetiology of oesophageal cancer?

A

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
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3
Q

What are the risk factors for oesophageal cancer?

A

Main:

  • Male
  • Smoking
  • Alcohol
  • GORD and Barrett’s oesophagus

Others:

  • Achalasia
  • Paterson-Kelly syndrome
  • Tylosis
  • Obesity
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4
Q

What is the epidemiology of oesophageal cancer?

A
  • Relatively common malignancy
  • Affects males more
  • Squamous cell carcinoma more common worldwide
  • Adenocarcinoma more common in westernised countries
  • Peak incidence: 60–70 years
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5
Q

What are the presenting symptoms of oesophageal cancer?

A

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)
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6
Q

What are the presenting signs of oesophageal cancer?

A
  • 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)

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7
Q

What investigations would you do if you were suspecting oesophageal cancer and what would you expect to see??

A
  • 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)
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8
Q

What is the management for oesophageal cancer?

A

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
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