Oesophageal carcinoma

Question 1

What are the types of oesophageal cancer?

Answer 1

Squamous cell and adenocarcinoma

Question 2

What are risk factors for SCC of oeophagus?

Answer 2

Upper/mid oesophagus: associated with smoking, alcohol, HPV

Question 3

What are risk factors for oesphageal adenocarcinoma?

Answer 3

Lower oesophagus: Barret’s, GORD, fat, smoking + alcohol

Question 4

What are Sx of oesophageal cancer?

Answer 4

Often vague leading to late presentation.

Dysphagia
Weight loss
Anaemia

Odynophagia
Hoarseness
Post-prandial cough
haematemesis and melaena if bleed

Question 5

What are DDx for oesophageal cancer?

Answer 5

• Benign stricture
• Achalasia
Barrett’s

Oesphageal web
Pharyngeal pouch
Achalasia

Question 6

What Ix in oesophageal cancer?

Answer 6

OGD with biopsy: within 2 weeks.

CTCAP/PET scan/endoluminal US with biopsy: for staging and biopsying lymph nodes

Staging laparoscopy: for junctional tumuors at LOS to look for peritoneal masses

Question 7

What is Rx for oesophageal cancer

Answer 7

For SCC, give chemo-radiotherapy since difficult to operate on

For adeno, above plus oesophageal resection

Some T1a tumours can be treated with endoscopic mucosal resection

Question 8

What does oesophagaectomy involve?

Answer 8

Involves removal of the tumour, top of the stomach, and surrounding lymph nodes. The stomach is then made into a tube (“the conduit”) and brought up into the chest to replace the oesophagus.

Scar on stomach (rooftop) and in neck.

Question 9

What are complications of oesophagectomy?

Answer 9

Anastomotic leak
Re-operation
Pneumonia
death

Food: need 5-6 small meals a day to avoid dumping syndrome, may need a feeding jejunostomy if this is difficult.

Question 10

What is palliative management of oesophageal cancer

Answer 10

• Oesophageal stent: for dysphagia
• Radio and chemo to reduce tumour size
Nutritional support