Oesophageal Cancer

Question 1

What is the incidence of oesophageal cancer

Answer 1

• UK <9/100.000/yr
• Australia <5/100.000/yr
• Iran >100/100.000/yr

Question 2

What are the risk factors of oesophageal cancer

Answer 2

• Male
• diet
• alcohol excess - smoking
• achalasia
• reflux oesophagitis +/- Barrett’s oesophagus
• obesity
• hot drinks
• nitrosamine exposure
• Plummer-vinson syndrome

Question 3

What is the site of oesophageal cancer

Answer 3

• 20% occur in the upper part; 50% in the middle part; 30% in the lower part
• squamous cell carcinoma (proximal) or adenocarcinoma (distal)

Question 4

What is the presentation of oesophageal cancer

Answer 4

• dysphagia
• weight loss
• retrosternal chest pain

Signs from upper third oesophagus

• hoarseness
• cough

Question 5

What are the investigations for oesophageal cancer

Answer 5

• oesophagoscopy with biopsy
• EUS, CT/MRI for staging
• laparoscopy if infra-diaphragmatic component

Question 6

Name the TNM staging of oesophageal cancer

Answer 6

• Tis - carcinoma in situ
• T1 - invading lamina propria/submucosa
• T2 - invading muscular propria
• T3 - invading adventitia
• T4 - invasion of adjacent structures
• Nx - nodes cannot be assessed
• NO - no node spread
• N1-N3 - regional node metastases
• M0 - no distant spread
• M1 - distant metastasis

Question 7

What is the treatment of oesophageal cancer

Answer 7

Survival rates poor with or without treatment

• Radical curative oesophagectomy +/- pre-op
• chemo - if localised T1/T2 disease
• Palliation - if advanced disease, aim to restore swallowing with chemoradiotherapy, stenting and laser use