Oesophageal carcinoma

Question 1

what are the two main types of oesophageal carcinoma?

Answer 1

Adenocarcinoma

Sqaumous cell carcinoma

Question 2

where do adenocarcinoma’s usually affect?

Answer 2

the lower 1/3rd of the oesophagus

Question 3

where do squamous cell carcinoma’s usually affect?

Answer 3

upper 2/3rd of oesophagus.

Question 4

what are the risk factors for adenocarcinoma’s?

Answer 4

GERD
achalacia
obesity
smoking

Question 5

what are the risk factors for SCCs?

Answer 5

drinking hot beverages
smoking
alcohol
poor diet (low in fruits and vegetables)
Nitrosamines exposure (cured meats, fish and bacon)

Question 6

what is the primary symptom that patients normally present with?

Answer 6

progressive dysphagia. (from solids to liquids) and possible onophygaia.

Question 7

what are other symptoms that might be present? (3)

Answer 7

weight loss
haematesis
hoarseness

Question 8

what is the primary diagnostic test?

Answer 8

endoscopy

Question 9

what is the epidiomology of the cancer?

Answer 9

more male than females.
peak incidence is 60-70 years of age.
SCC is the most common type worldwide

Question 10

what are less common features?

Answer 10

hematemesis, melena

hoarness

Question 11

what tests can you do?

Answer 11

Oesophagoscopy with biopsy is the investigation of choice +- EUS, CT/MRI for staging or laparoscopy if significant infra-diaphragmatic component.

TNM staging look at oxford handbook p.618.

Question 12

what do you look for in a barium swallow?

Answer 12

Asymmetrical and irregular borders of the oesophagus with characteristic stenosis and proximal dilatation (apple core lesion)

Sensitive, but does not allow confirmation or staging of malignancy. Inferior to endoscopy, but indicated in the case of:
Severe stricture that inhibits endoscopic evaluation
Suspected tracheoesophageal fistula due to oesophageal cancer

Question 13

what is the treatment for oesophageal cancer?

Answer 13

If localised T1/T2 disease, radical curative oesophagostomy may be tired. Pre-op chemotherapy (cisplatin + fluorouracil) for localised disease may improve survival, but causes some morbidity.

If surgery is not indicated, then chemo radiotherapy may be better than radiotherapy alone.

Palliation in advanced disease aims to restore swallowing with chemo/radiotherapy, stenting, and laser use.