Oesophageal Carcinoma

Question 1

Pathology

Answer 1

• adenocarcinoma (common): lower third of oesophagus
• squamous cell carcinoma: upper and middle third of oesophagus
• post-cricoid carcinoma: female and a/w Plummer-Vinson syndrome
• nodule–> ulcer–> papilliferous mass/ annular constriction

Question 2

Aetiology

Answer 2

• adenocarcinoma: Barrett’s oesophagus, obesity

- SCC: achalasia, tobacco, alcohol, coeliac disease

Question 3

Spread

Answer 3

• local invasion: trachea, lung, aorta (massive haemorrhage)
• lymphatic: paraoesophageal node, carinal, bronchial, supraclavicular, abdominal nodes
• hematogenous: liver, lung

Question 4

Clinical feature

Answer 4

• local symptom: dysphagia (initially solid then fluid)
• secondary deposit: enlarged neck nodes, occasionally jaundice and hepatomegaly
• general manifestation of malignant disease: loss of weight, anorexia, anaemia
• hoarseness and bovine cough: invasion of left recurrent laryngeal nerve by upper oesophageal tumour

Question 5

Investigation

Answer 5

• FBC
• U&E
• LFT
• barium swallow: shouldered stricture
• CXR: mediastinal widening, secondaries in lung
• OGD with biopsy: combine with endoluminal ultrasound to evaluate local invasion
• endoscopic ultrasound: assess tumour’s depth of invasion and detection of local and lymphatic spread, fine needle aspiration of lymph nodes to facilitate pre-op staging
• CT of thorax and abdomen: assess primary growth, local invasion and secondary spread to liver and lymph nodes
• Positron emission tomography (PET): screen metastatic disease and stage the tumour (not useful for primary growth)
• laparoscopy: exclude peritoneal metastases prior to resection

Question 6

Treatment

Answer 6

Curative
- resection following course of chemotherapy: growth is removed and defect is bridged by mobilization of stomach up into chest with anastomosis to residual oesophagus or pharynx in neck

Palliation

• intubation: stent may relieve dysphagia
• endoscopic laser therapy: vaporize the growth and restore lumen
• radiotherapy: external beam or intraluminal (squamous tumour)
• chemotherapy: with platinum-based regimen, combined with radiotherapy