Oesophageal Tumours Flashcards
they can either be benign(rare) or malignant, what are some examples of benign tumours?
squamous papilloma
Leiomyomas
Lipomas
Really rare : Firbovascular polyps and granular cell tumours
what is the commonest benign tumour?
squamous papilloma
This is __,____ long and is often found incidentally as it is ______
small, 1-2, assymptomatic
what is associated with sqamous papilloma in a number of cases?
HPV
what are the different malignant tumours? 2
- squamous cell
- adenocarcinoma
in which group is squamous cell carcinoma more common?
males
the causes of squamous cell carcinoma are still quite unknown but what are some of the asociations?
- Vitamin A, zinc deficiency
- Tannic acid / strong tea
- Smoking and alcohol - probably - the most important for this - country
- HPV
- Oesophagitis
- Genetic
Diets high in fibre probably ______ the risk and those high in red meat and processed meat have been associated with an ______ risk
Diets high in fibre probably decrease the risk and those high in red meat and processed meat have been associated with an increased risk
macroscopically squamous cell carcinomas ___ the __-
occlude the lumen
adenocarcinoma is more common in ____ and ____
caucasians and males
in which third of the oesophagus is adenocarcinoma most common?
in the lower 1/3rd
___ ____ generally is the precursor for adenocarcinoma?
barrett’s oesophagus
Macroscopically adenocarcinomas they are similar to _____ carcinomas but the surrounding mucosa often has a___ __ appearance of _______
Macroscopically they are similar to squamous carcinomas but the surrounding mucosa often has a velvety pink appearance of barrett’s
Microscopically in adenocarcinoma there are ____-___ structures
Microscopically there are gland like structures
cells in adenocarcinoma have prominent ____
nuclei
how do oesophageal carcinomas metastasise? 3
direct invasion
lymphatic permeation
vascular invasion - haematogenous spread to the liver
what are the signs of oesophageal cancer?
Weight loss
Paraneoplastic syndrome
- Hypercalcaemia
- Inappropriate hormone production
Adenopathy
Effusion
Hepatomegaly
what are the sYMPTOMS of oesophageal cancer?
Dysphagia Odynophagia Haematemesis Regurgitation Dysphonia
Obstruction eventually leads to problems in swallowing ____. ____ and _____ into the lungs is common
Obstruction eventually leads to problems in swallowing saliva and coughing and aspiration into the lungs is common
what signs are picked up on the physical examination
Weight loss, lymph nodes, liver
what tests are done?
oesophagoscopy (laparoscopy if there is an infra-diaphragmatic component)
CT/MRI - useful for stging
barium swallow - not very useful
what are the treatment options?
- palliation
- surgery
radiotherapy - chemotherapy
- intubation/stents
- canalisation
what is involved in palliation?
Palliation aims to restore swallowing with chemo/radiotherapy, stenting and laser use
what is the curative option?
surgery
can also give radical radioteherapy
only ___% of patients are suitable for surgery
50
__ ___ ____ may improve survival q
pre -op chemo
what can be removed in surgery?
the oesphagus part and lymph nodes
what are the contraindications to surgery ? 5
- Direct invasion of adjacent structures: trachea or bronchus, aorta, pericardium, lung
- Fixed cervical lymph nodes
- Widespread metastases
- Poor medical condition
- long tumours
what are the adverse prognostic factors ? 3
Oesophageal obstruction
Tumour longer than 5cm
Metastatic disease
