oesophagus

Question 1

Oesophagus Cancer represents how many percent of all cancers?

Answer 1

2.2%

Question 2

Oesophagus Cancer is the ___ leading cause of cancer death worldwide?

Answer 2

6th

Question 3

After 5 years of having Oesophagus cancer what is your chance of survival after 5 years?

Answer 3

25%

Question 4

At what age is your chance of getting oesophagus cancer highest and lowest?

Answer 4

peak 60-70 years
under 25 (rare)

Question 5

What are risk factors of getting Oesophageal cancer? (SCC)

Answer 5

-Tobacco & Alcohol
• Diet
• Achalasia
• Head & Neck cancer
• Tylosis, Coeliac
disease & Lye
ingestion

Question 6

What are risk factors of getting Oesophageal cancer? (adenocarcinoma)

Answer 6

Barrett’s oesophagus
• Chronic reflux
• Smoking
• Obesity

Question 7

Causes of endemic oesophageal cancer?

Answer 7

Endemic oesophageal cancer
• “Oesophageal cancer belt”
• Poor nutrition
• Low intake fruit and vegetables
• Drinking hot beverages
• No sex bias in endemic variety

Question 8

Where does the Sub-mucosal Plexus drain to?

Answer 8

internal jugular, peri-tracheal, sub-carinal, perioesphageal,
peri-aortic, peri-cardial, lesser
curve of stomach

Question 9

Where can cancer in the cervical oesophagus spread to?

Answer 9

– carotids, pleura, Rec laryngeal nerve, trachea

Question 10

Which route of spread is the most common?

Answer 10

Sub-mucosal spread

Question 11

Where can the middle third of the Oesophagus spread to?

Answer 11

bronchi, thoracic duct, aortic arch, azygos, (R)

pleura

Question 12

Lower third can spread to?

Answer 12

pericardium, (L) pleura, descending aorta

Question 13

Presenting symptoms of oesophageal cancer?

Answer 13

Dysphagia
• Anorexia
• Weight loss
• Pain
• Vomiting
• Symptoms dependent on location of tumour

Question 14

How is Oesophageal cancer diagnosed?

Answer 14

Biopsy confirmation, usually performed at
endoscopy
• Barium swallow (can suggest Dx)
• Endoscopy (define site and longitudinal
extent of lesion)
• Histology

Question 15

Investigations into Oesophageal cancer can include…?

Answer 15

CT scan (chest/abdo)
• Endoscopic ultrasound
• PET/CT
• FBE/U&Es/LFTs
• Panendoscopy
• Laparoscopy
• ECG &Respiratory function tests

Question 16

What is an endoscopic ultrasound used to determine?

Answer 16

• Used to determine extent of invasion of

oesophageal wall

Question 17

Describe stage 1 of oesophageal cancer and the chance of survival after 5 years?

Answer 17

T0N0M0 60%

Question 18

Describe stage 2 of oesophageal cancer and the chance of survival after 5 years?

Answer 18

T2-3N0M0 31%

Question 19

Describe stage 3 of oesophageal cancer and the chance of survival after 5 years?

Answer 19

T3N1M0 20%

Question 20

Describe stage 4 of oesophageal cancer and the chance of survival after 5 years?

Answer 20

anyT,anyN, MI

4%

Question 21

Curative therapies for oesophageal cancer?

Answer 21

Surgery
• Radiation therapy
• Combined modality therapy
 1) CT/RT (definitive or adjuvant)
 2) Neoadjuvant

Question 22

Reasons for disease being unresectable?

Answer 22

1) Distant metastases
2) Disease un-resectable
3) Medically unfit for surgery
4) Refuse surgery

Question 23

Goals of palliative treatment?

Answer 23

• Restore or maintain swallowing
• Manage pain
• Prevent bleeding

Question 24

Candidates for palliation?

Answer 24

• Local symptoms and distant metastatic
disease
• Poor Performance Status
• Inadequate respiratory function
• Very large tumours

Question 25

Acute effects of treatment?

Answer 25

``` ACUTE EFFECTS • Lethargy • Skin erythema • Dysphagia • Odynophagia • Risk of neutropaenic sepsis • Pericarditis ```

Question 26

Late effects of treatment?

Answer 26

* LATE EFFECTS * Pulmonary fibrosis * Second malignancy * Hypothyroidism * Increased risk of IHD * Benign stricture

Question 27

Organs at risk and DVH tolerances?

Answer 27

– Lung, any >20Gy is destroyed – Limit V20 (the volume receiving >20Gy) to 30- 35% – Spinal cord limited to <46Gy @ 2 Gy fractions – Cervical oesophagus may allow 50Gy/30

Question 28

Typical field arrangements for Oesophagus planning?

Answer 28

– Anterior,Posterior,(L) lateral,(R) lateral – Anterior. Posterior and obliques – for palliative treatment may use AP-PA fields

Question 29

Where would wedges usually be required for an Oesophagus plan?

Answer 29

– Wedges usually required in laterals