oesophageal carcinoma

Question 1

What are the 2 most common forms of oesophageal carcinoma?

Answer 1

Adenocarcinoma

Squamous Cell Carcinoma

Question 2

Where are Squamous cell carcinomas usually located?

Answer 2

Upper 2/3

Question 3

Where are adenocarcinomas located?

Answer 3

Lower 1/3

Question 4

Why is adenocarcinoma located lower?

Answer 4

because metaplasia at lower 1/3 is more common due to Barret’s oesophagus causing metaplasia from stratified squamous epithelium to columnar
-> adenocarcinoma

Question 5

What RF are there?

Answer 5

tobacco (10x SSC 3xAC) and alcohol
Barret’s (AC)
Chronic inflamm (strictures) - SSC

Question 6

Why does oesophageal cancer present late?

Answer 6

75% of circumference is involved before ‘food sticking’ occurs
1/2 of pt present when unresectable or distant mets

Question 7

What are some signs and symptoms?

Answer 7

• Dysphagia
• Weight loss
• Loss of appetite
• Odynophagia
• Hoarseness
• Melaena
• Retrosternal pain
• Intractable hiccups
• Lymphadenopathy

Question 8

What are some differential diagnosis for oesophageal carcinoma?

Answer 8

• Oesophageal stricture from any cause.
• Compression of the oesophagus from external sources - eg, enlarged lymph glands or bronchial carcinoma.
• Achalasia.
• Gastric cancer.
• Intramural benign tumours - eg, leiomyoma.
• Metastatic tumours - most commonly from breast.

Question 9

Investigations for Oesophageal Carcinomas?

Answer 9

• FBC, U&E, LFT, glucose, CRP.
• Urgent endoscopy - with brushings and biopsy of any lesion seen.

Other possible staging investigations include:
•CXR - looking for evidence of metastases.
•Double-contrast barium swallow.
•CT/MRI scan of the chest and upper abdomen - for staging purposes.

Question 10

Treatment

Answer 10

•Antibiotic and antithrombotic prophylaxis should be instituted.
•Endoscopic mucosal resection and submucosal dissection is an option for patients with early oesophageal cancer
- endoscopic oesophagestomy