Oesophagus

Question 1

In which layers of the oesophagus are the glands that secrete lubricating mucous located?

Answer 1

Submucosa

Question 2

What cell types makes up the muscosa layer of the oesophagus

Answer 2

Non-keratinized stratified squamous epithelium

Question 3

What is the location of the oesophagus

Answer 3

Connects the inferior laryngopharynx to the sup portion of the stomach. Found posteriorly to the trachea and anteriorly to the vertebral column. Runs through the mediastinum.

Question 4

What is the superficial layer of the oesophagus called and what is its function?

Answer 4

Adventitia - connects the oesophagus to surrounding structures in the mediastinum due to its collapsible tube nature.

Question 5

What is the name of the areola connective tissue found in the mucosa layer of the oesophagus?

Answer 5

Lamina Propria

Question 6

What is another name for swallowing and what is it?

Answer 6

Deglutition - movement of food/drink from the oral cavity to the stomach

Question 7

What are the functions of the upper and lower oesophageal sphincter?

Answer 7

Upper - allows passage of food from the pharynx to the oesophagus

Lower - allows passage of food from the oesophagus to the stomach

Question 8

What occurs during the voluntary and pharyngeal phases of swallowing?

Answer 8

Voluntary - tongue pushes food/drink to back of oral cavity and into the oralpharnyx
Pharyngeal - nasopharynx is closed off by rising of the soft palate and uvula, epiglottis closes the entry to the larynx, upper oesophageal sphincter relaxes and bolus passes through to the oesophagus from the laryngopharynx

Question 8

What are the names of the 3 stages of swallowing?

Answer 8

Voluntary stage
Pharyngeal stage
Oesophageal stage

Question 9

Describe the process of peristalsis within the oesophageal stage of swallowing

Answer 9

Bolus enters the oeophagus
Circular muscalris sup to bolus contracts constricting the oephagus narrowing the walls pushing food toward the stomach. Longitudinal muscles inf to bolus also contract shortening and widening the walls allowing space for bolus to move into.

Question 10

What is achalasia

Answer 10

Failure of lower oesophageal sphincter to relax normally causing slow passage of food into the stomach. Food gets lodged.

Question 11

Roughly how long does it take for food to travel from the oral cavity to the stomach

Answer 11

4-8 seconds.

Question 13

What is GORD

Answer 13

GORD is where there is failure of the lower oesophageal sphincter to contract and close properly after food has entered the stomach causing the stomach acid to reflux back into the oesophagus causing a burning sensation.

Question 14

Give 3 preventable risk factors of oesophageal cancer

Answer 14

Alcohol
Tobacco
Obesity

Question 15

Name a condition of the oesophagus that increases the risk of oesophageal cancer

Answer 15

Barrett’s oesophagus

Question 16

What is Barrett’s oesophagus?

Answer 16

A condition where over time the stratified epithelium lining the mucosa are replaced with columnar epithelium. This change of cell type increases the risk of cancer forming.

Question 17

What is dyplasia?

Answer 17

Abnormal cell presence within a tissue or organ

Question 18

Name 5 common signs/symptoms of oesophageal cancer

Answer 18

Dysphagia
Unexplained weight loss
Regurgitation
Haematemesis
Coughing

Question 19

Name 3 observations that may be undertook during a clinical examination of oesophageal cancer

Answer 19

Englarged nodes in the cervival/supraclavicular region

Enlarged liver (heptomegaly)

Ascites (build up of fluid in the abdomen)

Question 20

What is a gastroscopy?

Answer 20

Type of endoscopy for the oesophagus -
Sticks a camera down the gullet to visualise tumour/cancerous cells. Can take a biopsy

Question 21

What is the most common type of oesophageal cancer and where does this occur?

Answer 21

Adenocarcinoma
Lower 3rd (where the glandular tissue is present)

Question 22

What are common sites for metastatic spread of oesophageal cancer?

Answer 22

Liver
Lungs

Question 23

What is the process called for surgical removal of part of the oesophagus?

Answer 23

Oesophagectomy

Question 24

In what scenarios is Radiotherapy given to treat oesophageal cancer

Answer 24

Alone for palliative treatment

Post surgery

Pre surgery with concomitant chemotherapy (as a radiosensitiser)

Question 25

Give 5 common side effects of radiotherapy of the oesophagus

Answer 25

1. Oesophagitis (after 30Gy)
2. Coughing
3. Pain when swallowing
4. Dysphagia
5. Regurgitation

Question 26

What is the standard prescription for radical oesophageal radiotherapy?

Answer 26

50Gy in 25#

Question 27

What is a palliative prescription for oesophageal radiotherapy?

Answer 27

8-10Gy in 1#

20-30Gy in 5-10#

Question 28

What technique is used for radical vs palliative radiotherapy of the oesophagus?

Answer 28

Radical - VMAT
Palliative - parallel opposed pairs

Question 29

What are the margins added to the GTV for oesophageal cancer to make up the CTV?

Answer 29

Additional 1cm laterally, ant and post
Additional 2cm sup and inf

Question 30

What is the % survival in oesophageal cancer for 10 years?

Answer 30

12%