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Y4: Upper GI Surgery > Oesophageal carcinoma > Flashcards

Oesophageal carcinoma Flashcards

1
Q

What are the two main types of oesophageal cancer?

A
  • Squamous cell carcinoma
  • Adenocarcinoma
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2
Q

Describe oesophageal cancer?

A
  • More common in men
  • Incidence of lower oesophagus / GO junction cancer rising
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3
Q

Describe squamous cell carcinoma of the oesophagus?

A
  • Developing world
  • Middle and upper 1/3s of the oesophagus
  • Assoication with alcohol, smoking, chronic achalasia, low vitamin A and hot drinks
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4
Q

Describe adenocarcinoma of the oesophagus?

A
  • Developed world
  • Lower third of the oesphagus
  • Occurs due to metaplasia
  • Risks are GORD and obesity
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5
Q

Describe the clinical features of oesophageal carcinoma?

A
  • Progressive dysphagia
  • Weight loss
  • Odynophagia, hoarseness, horners syndrome
  • Coughing when consuming liquids (fistula)
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6
Q

What do NICE guideliness say are the red-flag symptoms which require urgent endoscopy?

A
  • Dysphagia
  • >55yrs with weight loss, upper abdominal pain, dyspepsia or reflux
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7
Q

Differentials for oesophageal carcinoma?

A

Any patient should be presumed to have oesophageal cancer until proven otherwise

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8
Q

Describe investigations into oesophageal cancer?

A
  • Barium swallow
  • Urgent upper GI endoscopy (OGD)
    • Biopsy -> histology
    • CT scan for those not suitable for OGD
  • Further investigations
    • PET-CT for mets
    • Endoscopic US (measure penetration (T stage) and biopsy lymph nodes
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9
Q

Describe the management of oesophageal cancer?

A
  • 70% can only have palliative treatment
  • Curative management:
    • For most people this is surgery +/- chemo/chemoradiotherapy
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10
Q

Describe the curative management of SSCs of the oeosphagus?

A
  • Upper oesophagus SSCs are difficult to operate on
    • Chemoradiotherapy (CRT)
  • SSCs in middle/lower oesophagus
    • CRT +/- surgery
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11
Q

Describe the curative management of adenocarcinomas of the oeosphagus?

A
  • Neoadjuvant chemo/CRT followed by oesophageal resection
    • Less fit patients may only receive surgery
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12
Q

Describe the surgical management of oesophageal cancer?

A
  • Major surgery as both abdominal and chest cavities are opened
  • Patients have one lung deflated for 2 hours during surgery
  • Main complications: anastomotic leak, re-operation, pneumonia, death
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13
Q

What is a major post-op side effect in patients with oesophageal carcinoma?

A
  • Post-operative nutrition
    • Lose the reservoir function of the stomach
    • Some centres insert feeding tube into small bowel to aid nutrition
    • Most will need to eat 5-6 small meals per day to ‘graze’
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14
Q

Surgical techniques involved in oesophageal cancer surgery?

A
  • Oesophagectomy
    • Remove tumour, top of the stomach and lymph nodes.
  • The stomach is made into a tube and brought into chest to replace oesophagus.
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15
Q

Which surgical approach is termed the Ivor-Lewis procedure?

A

Right thoracotomy with laparotomy

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16
Q

Which surgical approach is termed the McKeown procedure?

A

Right thoracotomy with abdominal incision and neck incision

17
Q

Describe the left thoraco-abdominal incision technique?

A

One large incision starting above the umbilicus and extending round the back to below the left shoulder blade

18
Q

Describe an alternative procedure in those with early cancers or high grade Barret’s oesophagus?

A
  • Endoscopy mucosal resection (EMR)
    • Removal of just the mucosal layer of the oesophagus
    • Can be combined with radiofrequency ablation (RFA) or photodynamic therapy (PDT)
19
Q

Describe the palliative management of those with severe oesophageal cancer?

A
  • If there is difficulty swallowing => oesophageal stent where possible
  • Radiotherapy/chemotherapy can reduce tumour size and bleeding to improve symptoms
  • Photodynamic treatment can be used to kill certain cells
  • Nutritional support through thickened fluid and supplements
  • If dysphagia is too severe to tolerate enteral feeds:
    • Radiologically inserted gastrostomy (RIG) tube can bypass obstruction
20
Q

Describe the prognosis of oesophageal carcinoma?

A
  • Generally poor due to late presentation
    • 5-10% 5 year survival
21
Q

what vertebral level does the oesophagus originate?

A

C6

22
Q
A

Y4: Upper GI Surgery (8 decks)

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