Oesophageal Carcinoma

Question 1

What gender and age group is oesophageal carcinoma most common in?

Answer 1

Men

Ages 50-70

Question 2

What are the 2 types of oesophageal carcinoma?

Answer 2

• Squamous cell carcinoma (more common amongst smokers and associated with achalasia)
• Adenocarcinoma (more common in those with GORD)

Question 3

Why does oesophageal carcinoma have poor prognosis?

Answer 3

Presents at a high stage

Question 4

What are the risk factors of oesophageal carcinoma?

Answer 4

• Smoking
• Alcohol
• GORD
• Barrett’s oesophagus
• Achalasia (more for squamous cell carcinoma)
• Plummer Vinson Syndrome (small growths partially blocking oesophagus and iron defieincy anaemia)
• Diet rich in nitrosomaines

Question 5

What is Achalasia?

Answer 5

Condition in why the muscles of the lower oesophagus fail to relax

Question 6

What is Plummer Vinson Syndrome?

Answer 6

Rare disease characterised by:

• Iron deficiency anaemia
• Dysphagia
• Oesophageal webs

Question 7

What are the clinical features of oesophageal carcinoma?

Answer 7

• Progressive dysphagia
• Weight loss or anorexia
• Retrostrenal chest pain
• Vomiting

=> Signs that the carcinoma is located in the upper third of oesophagus:

• Hoarseness of voice
• Cough

Question 8

What is the pathophysiology of oesophageal carcinoma?

Answer 8

=> 2 main causes:

• Alcohol
• GORD and Barrett’s oesophagus

=> Alcohol:

• Alcohol broken down by enzymes forming acetylaldehyde
• Acetylaldehyde is carcinogenic, inhibiting DNA repair and causing point mutation in lymphocytes - Results in squamous cell carcinoma

=> GORD and Barrett’s oesophagus:

• Chronic GORD leads to Barrett’s oesophagus
• Can progress to dysplasia through activation of proto-oncogenes and disabling of tumour surpressor genes
• Adenocarcinoma

Question 9

What are the investigations in suspected oesophageal carcinoma?

Answer 9

=> Upper GI Endoscopy - first line

=> CT Chest, Abdo, Pelvis
Used to determine if carcinoma has metastasised

=> Staging laproscopy

Question 10

What staging is used in oesophageal carcinoma?

Answer 10

=> TNM

=> T stage

Tis - carcinoma in situ
T1 - invading lamina propria
T2 - invading muscularis propria
T3 - invading adventitia
T4 - invasion of adjacent structures

=> N stage

Nx - nodes cannot be assessed
No - no nodal spread
N1-3 - regional node spread

=> M Stage

Mo - No distant spread
M1 - distant metastasis

Question 11

What is the management of oesophageal carcinoma?

Answer 11

=> Curative intent

Surgical resection (Lewis type oesophagectomy) with adjuvant chemotherapy

=> Palliative intent

• Radiotherapy
• Stenting