oesophagus Flashcards
Oesophagus Cancer represents how many percent of all cancers?
2.2%
Oesophagus Cancer is the ___ leading cause of cancer death worldwide?
6th
After 5 years of having Oesophagus cancer what is your chance of survival after 5 years?
25%
At what age is your chance of getting oesophagus cancer highest and lowest?
peak 60-70 years under 25 (rare)
What are risk factors of getting Oesophageal cancer? (SCC)
-Tobacco & Alcohol • Diet • Achalasia • Head & Neck cancer • Tylosis, Coeliac disease & Lye ingestion
What are risk factors of getting Oesophageal cancer? (adenocarcinoma)
Barrett’s oesophagus
• Chronic reflux
• Smoking
• Obesity
Causes of endemic oesophageal cancer?
Endemic oesophageal cancer • “Oesophageal cancer belt” • Poor nutrition • Low intake fruit and vegetables • Drinking hot beverages • No sex bias in endemic variety
Where does the Sub-mucosal Plexus drain to?
internal jugular, peri-tracheal, sub-carinal, perioesphageal,
peri-aortic, peri-cardial, lesser
curve of stomach
Where can cancer in the cervical oesophagus spread to?
– carotids, pleura, Rec laryngeal nerve, trachea
Which route of spread is the most common?
Sub-mucosal spread
Where can the middle third of the Oesophagus spread to?
bronchi, thoracic duct, aortic arch, azygos, (R)
pleura
Lower third can spread to?
pericardium, (L) pleura, descending aorta
Presenting symptoms of oesophageal cancer?
Dysphagia • Anorexia • Weight loss • Pain • Vomiting • Symptoms dependent on location of tumour
How is Oesophageal cancer diagnosed?
Biopsy confirmation, usually performed at
endoscopy
• Barium swallow (can suggest Dx)
• Endoscopy (define site and longitudinal
extent of lesion)
• Histology
Investigations into Oesophageal cancer can include…?
CT scan (chest/abdo) • Endoscopic ultrasound • PET/CT • FBE/U&Es/LFTs • Panendoscopy • Laparoscopy • ECG &Respiratory function tests
What is an endoscopic ultrasound used to determine?
• Used to determine extent of invasion of
oesophageal wall
Describe stage 1 of oesophageal cancer and the chance of survival after 5 years?
T0N0M0 60%
Describe stage 2 of oesophageal cancer and the chance of survival after 5 years?
T2-3N0M0 31%
Describe stage 3 of oesophageal cancer and the chance of survival after 5 years?
T3N1M0 20%
Describe stage 4 of oesophageal cancer and the chance of survival after 5 years?
anyT,anyN, MI
4%
Curative therapies for oesophageal cancer?
Surgery • Radiation therapy • Combined modality therapy 1) CT/RT (definitive or adjuvant) 2) Neoadjuvant
Reasons for disease being unresectable?
1) Distant metastases
2) Disease un-resectable
3) Medically unfit for surgery
4) Refuse surgery
Goals of palliative treatment?
- Restore or maintain swallowing
- Manage pain
- Prevent bleeding
Candidates for palliation?
• Local symptoms and distant metastatic disease • Poor Performance Status • Inadequate respiratory function • Very large tumours
Acute effects of treatment?
ACUTE EFFECTS • Lethargy • Skin erythema • Dysphagia • Odynophagia • Risk of neutropaenic sepsis • Pericarditis
Late effects of treatment?
- LATE EFFECTS
- Pulmonary fibrosis
- Second malignancy
- Hypothyroidism
- Increased risk of IHD
- Benign stricture
Organs at risk and DVH tolerances?
– 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
Typical field arrangements for Oesophagus planning?
– Anterior,Posterior,(L) lateral,(R) lateral
– Anterior. Posterior and obliques
– for palliative treatment may use AP-PA fields
Where would wedges usually be required for an Oesophagus plan?
– Wedges usually required in laterals
