Oesophagus

Question 1

lymph node drain: upper cervical

Answer 1

deep cervical nodes

supraclavicular fossa

Question 2

Lymph node drain: upper thoracic

Answer 2

para oesophageal

nodes in the mediastinum

Question 3

lymph node drain: lower thoracic

Answer 3

para cardial nodes
left gastric nodes
lesser curvature nodes

Question 4

Radiotherapy dose: definitive

Answer 4

50 gray in 25 fractions with cpl 5fu

45 gray in 25 fraction if given preoperatively

Question 5

curative radiotherapy dose

Answer 5

55 gy in 20 daily fractions 2.75gy in 4 weeks

Question 6

esophagus parts:

Answer 6

cervical: UES-sternal(15-20cm), c7-t3
| 15-18cm(walter miller)
Thoracic

Question 7

upper thoracic

Answer 7

sternal notch to azygous vein
20-25cm
t3-t5, 18-24 cm(walter miller)

Question 8

middle thoracic anatomy

Answer 8

24-32cm(WM),
25-30 perez
azygous vein to inferior pulmonary vein

Question 9

lower thoracic extends

Answer 9

32-37cm wm
30-40cm perez
inferior pulmonary vein to lower esophagial junction

Question 10

esophagus CTV,PTV

Answer 10

ctv 50-66: gtv+ 3-5cm margin longitudinally, 0.5-1 cm margin axially, involved node+0.5-1cm
elective node: scln, mediastinal, peri oesophagel

Question 11

Reports included after biopsy

Answer 11

Include in pathology report:
• Invasion, if present; high-grade dysplasia in Barrett esophagus is reported
for staging purposes as intraepithelial neoplasia (dysplasia) (Tis)b,c,d
• Histologic type
•Grade
• Presence or absence of Barrett esophagus

Question 12

Common chemo protocol ccrt

Answer 12

Pacli 50mg/md1
Carbo auc 2 d1
Wkly 5 wks

Oxali 85mg/m2 d1
Leuco 400 mg/m2 d1
5fu 400mg/m2 iv push than 800mg/m2 overr 24 hr d1,d2
2wkly

Question 13

Adeno carcinoma periop ct

Answer 13

Perioperative chemotherapy:

FLOT: 4ceyele preop + 4 cycle post op:

5fu- 2600mg/mV-IN 24hrs. D1

Leucovorin - 2oomy/m -fx-By

oxaliplatin 85 mg/mv - D1

Docetaxel - 50mg/m² - At

QW2x RX 4

Question 14

Prognostc factors

Answer 14

Tnm stage
Histological type
Grading
Location of tumor: upper 1/3rd better prognosis
Performance stats

Question 15

Causes of dysphagia

Answer 15

Oropharyngeal: stroke, parkinson, myaesthenia gravis
Oesophageal injury: achalasia, scleroderma,
Mechanical:
Intrinsic: oesophageal carcinoma, peptic stricture, foreign body
Extrinsic: mediastinal mass, retrosternal goitre, bronchial carcinoma
Rare: pericardial effusion, thoracic aortic aneurysm.

Question 16

Treatment outcome in modalities oesophagus

Answer 16

Defntv ccrt: 5 yr os 27%

Pre op ct- sx: 5yr os 23%
3 yr os: 58%

Question 17

Esophageal cancer histopathologicalclassification

Answer 17

Squamous cell carcinoma
Basaloid
Spindle
Verrucous
adenocarcinoma
adenosquamous
carcinoid
non epithelial
Sarcoma
Malignant melanoma
Myoblastoma
Choriocarcinoma
Lymphoma