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Surgery- UGIT > Options For Managemnt Of Malignancies > Flashcards

Options For Managemnt Of Malignancies Flashcards

1
Q

Averagely, how long is the oesophagus?

A

25cm

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2
Q

Where does the oesophagus extend to and from?

A

C6-T11

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3
Q

Divide the lymphatic drainage of the oesophagus:

A

Upper 1/3rd of the oesophagus
- Supraclavicular and deep cervicle lymph nodes
Middle 1/3rd of the oesophagus
- Superior and posterior mediastinal nodes
Lower 1/3rd of the oesophagus
- Left gastric, splenic and coeliac lymph nodes

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4
Q

What is the significance of the oesophagus having no lymph nodes?

A

Facilitates in extra-oesophageal spread.

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5
Q

What are the layers of the oesophagus?

A
  1. Mucosa
  2. Submucosa
  3. Muscularis Propria
  4. Adventitia
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6
Q

What are the risk factors for a squamous cell carcinoma?

- (Upper 1/3rd oesophageal carcinoma)

A
  • Drinking hot beverages
    • Smoking
    • Betel nut ingestion
    • Alcohol
    • Deficiency of certain micronutrients i.e. sink, selenium, magnesium
    • Plummer Vinson syndrome
    • HPV
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7
Q

What are the risk factors for an adenocarcinoma in the oesophagus?
- (Lower 1/3rd oesophageal carcinoma)

A
  • GORD
    • Barrett’s oesophagus :- Metaplasia due to GORD
    • Obesity
    • Shmoking
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8
Q

What 3 congenital abnormalities influence the propensity of oesophageal carcinoma development?

A
  • Atresia
    • Tracheo-oesophageal fistula
    • Mucosal webs
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9
Q

Name 3 genetic abnormalities that influence the propensity of oesophageal carcinoma development?

A

Tylosis
- (Hyperkeratosis of the palms and soles, leukoplakia of the mouth)
Bloom syndrome
- Short stature, rash on the skin, mental retardation, inc leukaemia,
- Lymphomas
Fanconi Anaemi
- Cancers of bone marrow failure

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10
Q

What are the symptoms of oesophageal cancer?

A

Dysphagia
Weight loss
Odynophagia
Pain in the bone :- sign of metastases
Hoarse voice :- Impingement of the recurrent laryngeal nerve
Hemorrhage/empyema :- Infiltrate aorta/mediastinum/pericardium
SVC syndrome
Hornets syndrome
Tracheoseophageal/Bronchoesophageal fistulas

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11
Q

What is the grading of dysphagia?

A

0 :- Eat solid food without too much attention to swallowing
I :- Solid food <18mm, chewed thoroughly
II :- Semisolid food (equivalent to baby food)
III :- Liquids only
IV :- Unable to swallow liquids or saliva

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12
Q

Give 4 Diagnostic tests for oesophageal cancer detection:

A 
CT Scan 
Bloods 
  - Albumin, LFT, Renal function
Endoscopy 
  - Visualize extent of tumor 
  - Biopsies 
Endoscopy ultrasonograph 
  - Lymph once metastases 
  - Peri-oesophageal extent
Panendoscopy 
  - Used for cervical tumors
Tracheobronchoscopy
Laparoscopy 
  - For lower oesophageal tumours
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13
Q

What factors influence the prognosis of oesophagus carcinoma?

A 
Stage 
Tumor size 
Tumor length page 
OS 
LN Extracapsular extension.
Surgical margins
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14
Q

Name 2 roles of radiation therapy :

A
  1. Curative role
    - Definitive role
    - Neo-adjuvant
    - Adjuvant
  2. Palliative role
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15
Q

What is trimodality treatment?

A

Chemoradiation therapy

Followed by surgery 5-7 weeks later

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16
Q

What is surgeries role after chemoradiation?

A

Lowers the rate of local tumor recurrence

17
Q

What dose of radiotherapy is usually used?

A

41,1- 50,4 GY

18
Q

Name a few other oesophageal pathologies:

A 
Adenoid cystic
Mucoepidermoid 
Leiomyosarcoma
Lymphoma
Melanoma 
Karposi sarcoma
19
Q

What is Adjuvant chemotherapy?

A

In Adjuvant (also called postoperative or secondary) chemotherapy, drug treatment takes place after the surgical extraction of the tumor.

20
Q

What is Neo-adjuvant chemotherapy?

A

In neoadjuvant (also called preoperative or primary) chemotherapy, drug treatment takes place before surgical extraction of a tumor. This is in contrast with adjuvant chemotherapy, which is drug treatment after surgery.

21
Q

What drugs are used in Neo-adjuvant concurrent chemotherapy?

A
  • Paclitaxel/Carboplatin or
    • 5FU/Cisplatin or
    • Capecitabine/Cisplat
22
Q

Indications for adjuvant radiotherapy:

A

Patients that did not receive Neo-adjuvant treatment

  • T3/T4
  • Increase in lymph nodes.
  • Unfavourable T2 (histological grade, LV invasion, PN invasion, adequacy LND
23
Q

Briefly describe the radiotherapy simulation:

A
  • Patient in Supine position
    • Arms above head
    • Knee support
    • For a malignancy in upper oesophagus, use a thermoplastic head mask.
    • Oral contrast
    • Palpable neck disease, Mark with radio opaque marker

Patients with malignancies in distal oesophagus should be nil per os 3-4 hours prior to simulation
With daily treatments to limit variations in gastric bowel movement

24
Q

What 5 organs are at risk during oesophageal radiotherapy?

A
  • Heart
    • Liver
    • Lungs
    • Spinal chord
    • Kidneys
25
Q

What are signs of early radiotherapy-induced toxicity?

A
  • Oesophagitis
    • Weight loss
    • Fatigue
26
Q

What are signs of late radiotherapy-induced toxicity?

A

Oesohagel perforation
Pneumonitis
Oesophageal strictures
Pericarditis

27
Q

What are examples of palliative treatment procedures:

A

Stent placement
Dilatation
External beam radiotherapy
Brachytherapy

28
Q

What is the advantage of using brachytherapy as a palliative treatment procedure?

A

Longer duration of relief.

29
Q

What is the advantage of using stent placement as a palliative treatment procedure?

A

Rapid onset of relief

30
Q

What are the absolute contra-indications of using brachytherapy for palliative treatment?

A

Joesophageal fistulas
Cervical oesophageal location
Stenosis that can’t be bypassed

31
Q

What is brachytherapy?

A

Treatment of cancer by inserting radioactive implant in the tissue

Surgery- UGIT (9 decks)

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