Oesophageal Carcinoma Flashcards
What are the two main types of oesophageal carcinoma?
Adenocarcinoma
Sqaoumous cell carcinoma
What are the key features and associated factors of oesophageal carcinoma?
Most common in the UK
Affects the lower 1/3 of the O, near the OGJ
Associated with : GORD, Barrets Oesophagus, smoking and obesity
What are the key features and associated characteristics of oesophageal squamous cell carcinoma?
Most common in globally
Affects the upper 2/3 of the oesophagus
Associated with smoking, alcohol, achalasia, nitrosamines (meat, fish, beer), Plummer Vinson syndrome.
What is the relevant TMN staging for oesophageal carcinoma?
Tis = in siute, 1a up to muscularis mucosa 1b submucosa 2 muscularis proprioa, 3 adventitia, 4 adjacent structures a resectable b unresectable
N1 = ½ lymph nodes, 2 = 3-6lymph node , 3 = 7 or more regional lymph nodes.
M1 = distant metastasis.
What is the relevant epidemiology of oesophageal carcinoma?
Male
50-60yrs
GORD/BO - relevant for adenocarcinoma
Diet/alcohol - relevant for sqaoumous cell carcinoma
What are the relevant signs and symptoms for oesophageal carcinoma?
Often presents at advanced state as symptoms are mainly due to large mass of tumour.
Dysphagia
Weight loss (catabolic malignancy and decrease intake)
Odynophagia – painful swallowing
Hoarseness – invasion of recurrent lymph nodes
Retrosternal pain
Regurgitation or vomiting
What is the 2ww referall criteria for oesophageal and gastric cancer referall?
Dysphagia
OR
Aged 55yrs + with weight loss and one+ of the following: upper abdo pain/reflux/dyspepsia.
What are the common investigations to stage oesophageal carcinoma?
Endoscopy and biopsy
Endoscopic US – tumour depth, regional lymph nodes and invasion
Barium swallow – less sensitive but can show changes in mucosa or presence of a mass
CT – locoregional invasion and mets
PET – occult mets or synchronus malignancies
What are the common complications of oesophageal carcinoma?
Lymphatic metastasis = regional lymph nodes = mediastinal compression
Haemodynamic spread - liver and lungs
Generally poor prognosis - 20% at 5yrs.
What is the typically treatment used for curative disease in oesophageal carcinoma?
Surgical = early stage and localised, may include lymphadenectomy, videa-assisted thoracoscopic surgery or robot assisted.
Risk of anastamotic leak into the mediastinum.
What are the available palliative procedures in oesophageal carcinoma?
Endoscopic stenting
Laser ablation
Chemotherapy
What is the common chemotherapy offered in oesophageal carcinoma?
FLOT = fluorouracil (DNA synthesis), oxaliplatin (Damages DNA), docetaxel (Disrupts microtubles)
CX = cisplatin (DNA damage) and capecitabine (into Fluorouracil in cancer cells)
What are some potential targeted therapies offered for oesophageal carcinoma?
Note many are still in clinical trial
Trastuzumab – HER2 inhibitor (RAS pathway)
Nivolumab – PD-L1 antagonist
Pemrbolizumab –PD-1 receptor antagonis
What are some of the mechanism of cachexia in cancer?
Direct food intake – difficulty swallowing -> less nutrition intake
Increased basal metabolic rate -> proteolysis and lipolysis
Inflammatory mediators – TNFalpha and cytokines -> anorexia, glucagon, catecholamines -> catabolism.
What is meant by cachexia in cancer?
severe loss of muscle and fat mass (also in AIDs, COPD, HF)
Also = anorexia, anaemia, weakness and fatigue.
Present in 2/3 of advanced cancer patients.
20% of patients with solid cancers die from cachexia
