Oesophageal carcinoma

Question 1

Causes/risk factoers

Answer 1

• smoking
• alcohol
• diet
• barrets oesophagus (reflux)
• achlasia

Question 2

Types

Answer 2

• Adenocarcinoma
  
  • ​rapidly increasing incidence in western world
  • commonest in western europe
  • dietary nitrosamines, GORD and barrets metaplasia
  • lowe third of the oesophagus
• squamous carcinoma
  
  • ​reducing in wester world
  • smoking, alcohol intake, diet poor in fresh fruit and veg, chronic achlasia

Question 3

Clinical features

Answer 3

• dysphagia- any new symptoms of dysphagia, especially over the age of 45 should be assumed to be due to tumour until proven otherwise
• haematemesis - rarely the presenting symptom
• incidental screening - occasionaly as a result of follow up screening for barrats oesophagus
• features of disseminated disease - cervical lymphadenopathy, hepatomegaly due to emtastases, epigastric mass due to para-aortic lymphadenopathy
• symptoms of local invasion- distonia in reccurent laryngeal nerve, cough, haemoptysis, neck swelling, SVCO, horners syndrome

Question 4

Diagnosis

Answer 4

• Upper Gi endoscopy and biopsy
• barium swallow only for failed intubation
• staging
  
  • CT-chest/abdo- regional staging
  • endoscopic ultrasound - local staging for depth and invasion
  • laparoscopy
  • PET scan - disseminated disease

Question 5

Treatment

Answer 5

• palliative
  
  • Dysphagia - SEMS (stent), external bea radiotherapy
  • metastases - systemic chemo if syptomatic
  • laser
  • chemo
  • radiotherapy
• surgery (if localised and resectable)
• chemotherapy - before surgery in some cases to incrrease chance of tumour being operable