Pathology of the oesophagus and mouth

Question 1

What is a common form of oesophagitis?

Answer 1

chronic

Question 2

Describe chronic oesophagitis?

Answer 2

Reflux disease ‘reflux oesophagitis’

- rare causes include Crohn’s disease

Question 3

Describe acute oesophagitis?

Answer 3

Corrosive following chemical ingestion

- Infective in immunocompromised patients e.g. candidiasis, herpes, CMV

Question 4

What is reflux oesophagitis? Aeitology?

Answer 4

Inflammation of oesophagus due to refluxed low pH gastric content
Due to:
defective sphincter mechanism +/- Hiatus hernia
Abnormal oesophageal motility
Increased intra-abdominal pressure (pregnancy)
Obesity

Question 5

What are the consequences of reflux oesophagitis?

Answer 5

Ulceration (bleeding)
Stricture - narrowing of the oesophagus
Barrett’s Oesophagus

Question 6

Describe Barrett’s Oesophagus?

Answer 6

Replacement of stratified squamous epithelium by columnar epithelium due to persistent reflux of acid or bile

Question 7

What are the consequences of Barrett’s Oesophagus?

Answer 7

Unstable mucosa (continuing damage)

Increased risk of developing dysplasia and carcinoma of the oesophagus

Question 8

What is allergic oesophagitis? What are the predisposing factors?

Answer 8

‘Eosinophillic’ oesophagitis
Personal/family history of allergy
Asthma
Young
Males > females
pH probe negative for reflux
Increased eosinophils in blood
Corrugated (feline) or ‘spotty’ oesophagus

Question 9

What is the treatment for allergic oesophagitis?

Answer 9

Treatment may include steroids/ chromoglycate/ montelukast

Question 10

What is the most common bengin oesophageal tumour? What is it related to?

Answer 10

Squamous papilloma

HPV

Question 11

Name some very rare benign oesophageal tumours?

Answer 11

Leiomyomas
Lipomas
Fibrovascular polyps
Granular cell tumours

Question 12

What are the most common malignant oesophageal tumours?

Answer 12

Squamous cell carcinoma

Adenocarcinoma - now most common

Question 13

What can cause squamous cell carcinoma?

Answer 13

Vitamin A, Zinc deficiency
Tannic acid/ Strong tea
Smoking, Alcohol
HPV
Oesophagitis
Genetic

Question 14

What disease causes an increased risk of developing an adenocarcinoma of the oesophagus?

Answer 14

Barrett’s Oesophagus

Question 15

What is the adenocarcinoma cascade?

Answer 15

Genetic factors + reflux disease ->
Chronic reflux oesophagus ->
Barrett's Oesophagous ->
Low grade dysplasia ->
High grade dysplasia ->
ADENOCARCINOMA

Question 16

How do carcinomas of the oesophagus spread?

Answer 16

Local invasion

• Direct invasion
• Lymphatic permeation
• Vascular invasion

Question 17

What are the clinical signs of carcinomas of the oesophagus?

Answer 17

Dysphagia
General symptoms of malignancy
- Anaemia,
- Weight loss, loss of energy

Question 18

What is the most common type of oral cancer?

Answer 18

Squamous Cell Carcinoma

Question 19

What are the causes of oral cancer?

Answer 19

Tobacco
Alcohol
Betel quid
Chronic infections
HPV
Viral
Nutritional deficiencies
Genetics
Post Transplant
Pt with history of primary oral SCC, increased risk of developing new second primary

Question 20

Treatment of oral cancers?

Answer 20

Surgery
Chemotherapy
Radiotherapy