Oesophageal cancer

Question 1

What are the 2 main types of oesophageal carcinoma?

Answer 1

Adenocarcinoma and squamous cell carcinoma

Question 2

Where does oesophageal cancer rank in the most common cancers in the UK?

Answer 2

13th most common cancer in the UK

Question 3

What has happened to the incidence of oesophageal cancer?

Answer 3

Incidence has increased, particularly in men.

Question 4

Does oesophageal cancer affect men or women more commonly?

Answer 4

Men

Question 5

What age group is most affected by oesophageal cancer?

Answer 5

Over 60-79 accounts for about 85% of cases.

Question 6

What are the major risk factors for oesophageal cancer? (Adenocarcinoma and SCC)

Answer 6

Adenocarcinoma:

• Obesity
• Severe reflux
• Barrett’s oesophagus (precursor of AC)

SCC
- Heavy smoking & alcohol use - increases risk for both but smoking particularly increases the risk for SCC.

Question 7

Explain the changes which occur in Barrett’s oesophagus

Answer 7

• Oesophagus is lined with squamous epithelial usually
• Stomach lined with glandular columnar epithelial cells with mucin usually
• If acid refluxes back into the oesophagus, the squamous cells on the oesophagus will die off and cause reflux symptoms (heartburn)
• Over time, the oesophagus squamous cells are replaced with glandular columnar epithelial cells to adapt to the acid reflux - there is intestinal metaplasia in the normal squamous epithelium of the oesophagus to columnar cells
• These cells are unstable in the oesophagus and develop into cancer

Question 8

Risk factors for Barrett’s oesophagus?

Answer 8

White men who have had GORD for long time.

Tobacco use and obesity and additional risk factors.

Question 9

What are the survival rates like for oesophageal cancer?

Answer 9

Prognosis is often very poor - usually patients present at quite a late stage due to not screening programme in the UK.
For those diagnosed in their 70’s (usually when diagnosed) 5 year survival rates are <10%

Question 10

How common is gastric cancer? What is the most common form of stomach cancer?

Answer 10

Gastric cancer is the 5th most common cancer in the world and 3rd leading cause of death in both sexes worldwide.
Adenocarcinoma most common form.

Question 11

What is happening to incidence rates for gastric carcinoma?

Answer 11

Incidence decreasing

Question 12

Is gastric carcinoma more common in males or females? What age is it commonly diagnosed in?

Answer 12

Males (almost double)

95% gastric cancers diagnosed in those aged over 55 and peaks at 70.

Question 13

What are some risk factors for gastric cancer?

Answer 13

• H pylori, pernicious anaemia, smoked or pickled food diet, smoking
• genetic change (familial risk) leading to invasive carcinoma

Question 14

What are some red flag signs for incurable disease of gastric cancer?

Answer 14

• Epigastric mass
• Hepatomegaly
• Jaundice
• Ascites
• Troisier’s sign (enlarged supraclavicular node - virchow’s node)
• Acanthosis nigricans

Question 15

What is the differentiation between early and late gastric cancer (where it invades).

Answer 15

Early: invades through mucosa into submucosa but no further
Late: invades into muscular wall

Question 16

What is linitus plastica?

Answer 16

• Linitis plastica is a type of adenocarcinoma.
• Linitis plastica spreads to the muscles of the stomach wall and makes it thicker and more rigid.
• This means that the stomach can’t hold as much and doesn’t stretch or move as it should when you’re digesting food.

Question 17

What is the overall 5 year survival rate for gastric carcinoma?

Answer 17

15% - many are picked up late as we do not screen for gastric cancers.