Oesophageal Tumours

Question 1

they can either be benign(rare) or malignant, what are some examples of benign tumours?

Answer 1

squamous papilloma
Leiomyomas
Lipomas

Really rare : Firbovascular polyps and granular cell tumours

Question 2

what is the commonest benign tumour?

Answer 2

squamous papilloma

Question 3

This is __,____ long and is often found incidentally as it is ______

Answer 3

small, 1-2, assymptomatic

Question 4

what is associated with sqamous papilloma in a number of cases?

Answer 4

HPV

Question 5

what are the different malignant tumours? 2

Answer 5

• squamous cell

- adenocarcinoma

Question 6

in which group is squamous cell carcinoma more common?

Answer 6

males

Question 7

the causes of squamous cell carcinoma are still quite unknown but what are some of the asociations?

Answer 7

• Vitamin A, zinc deficiency
• Tannic acid / strong tea
• Smoking and alcohol - probably - the most important for this - country
• HPV
• Oesophagitis
• Genetic

Question 8

Diets high in fibre probably ______ the risk and those high in red meat and processed meat have been associated with an ______ risk

Answer 8

Diets high in fibre probably decrease the risk and those high in red meat and processed meat have been associated with an increased risk

Question 9

macroscopically squamous cell carcinomas ___ the __-

Answer 9

occlude the lumen

Question 10

adenocarcinoma is more common in ____ and ____

Answer 10

caucasians and males

Question 11

in which third of the oesophagus is adenocarcinoma most common?

Answer 11

in the lower 1/3rd

Question 12

___ ____ generally is the precursor for adenocarcinoma?

Answer 12

barrett’s oesophagus

Question 13

Macroscopically adenocarcinomas they are similar to _____ carcinomas but the surrounding mucosa often has a___ __ appearance of _______

Answer 13

Macroscopically they are similar to squamous carcinomas but the surrounding mucosa often has a velvety pink appearance of barrett’s

Question 14

Microscopically in adenocarcinoma there are ____-___ structures

Answer 14

Microscopically there are gland like structures

Question 15

cells in adenocarcinoma have prominent ____

Answer 15

nuclei

Question 16

how do oesophageal carcinomas metastasise? 3

Answer 16

direct invasion

lymphatic permeation

vascular invasion - haematogenous spread to the liver

Question 17

what are the signs of oesophageal cancer?

Answer 17

Weight loss

Paraneoplastic syndrome

• Hypercalcaemia
• Inappropriate hormone production

Adenopathy

Effusion

Hepatomegaly

Question 18

what are the sYMPTOMS of oesophageal cancer?

Answer 18

Dysphagia
Odynophagia 
Haematemesis 
Regurgitation
Dysphonia

Question 19

Obstruction eventually leads to problems in swallowing ____. ____ and _____ into the lungs is common

Answer 19

Obstruction eventually leads to problems in swallowing saliva and coughing and aspiration into the lungs is common

Question 20

what signs are picked up on the physical examination

Answer 20

Weight loss, lymph nodes, liver

Question 21

what tests are done?

Answer 21

oesophagoscopy (laparoscopy if there is an infra-diaphragmatic component)

CT/MRI - useful for stging

barium swallow - not very useful

Question 22

what are the treatment options?

Answer 22

• palliation
• surgery
  radiotherapy
• chemotherapy
• intubation/stents
• canalisation

Question 23

what is involved in palliation?

Answer 23

Palliation aims to restore swallowing with chemo/radiotherapy, stenting and laser use

Question 24

what is the curative option?

Answer 24

surgery

can also give radical radioteherapy

Question 25

only ___% of patients are suitable for surgery

Answer 25

50

Question 26

__ ___ ____ may improve survival q

Answer 26

pre -op chemo

Question 27

what can be removed in surgery?

Answer 27

the oesphagus part and lymph nodes

Question 28

what are the contraindications to surgery ? 5

Answer 28

• Direct invasion of adjacent structures: trachea or bronchus, aorta, pericardium, lung
• Fixed cervical lymph nodes
• Widespread metastases
• Poor medical condition
• long tumours

Question 29

what are the adverse prognostic factors ? 3

Answer 29

Oesophageal obstruction
Tumour longer than 5cm
Metastatic disease