The Digestive System - oesophagus

Question 1

name 3 epidemiology & 3 risk factprs about oesophageal cancer?

Answer 1

9th most sommon cancer
peak age 60-70yrs
7000 cases diagnosed per yr in the UK
smoking, diet, alcohol

Question 2

what types of cancers arise and at what sections of the oesophagus?

Answer 2

SCC & adenocarcinoma
10% arise in upper 1/3 - SCC
90% arise in other 2/3 - adenocarcinoma

Question 3

where does oesophageal cancer commonly metatasise to?

Answer 3

liver, lungs & bone

Question 4

clinical features presented with oesophageal cancer?

Answer 4

weightloss, dysphagia (difficulty swallowing), regurgitation of food, cough

Question 5

what investigations are used for oesophageal cancer?

Answer 5

barium swallow, oesophagoscopy, unltrasound of liver, bronchoscopy, chest x-ray, FNA nodes, PET

Question 6

what nodes are involved with oesophageal cancer in each 3rd?

Answer 6

upper-cervical nodes
midlle - mediastinal, perigastric nodes
lower - coeliac nodes

Question 7

what disease management options are available for cancer of the oesophagus?

Answer 7

supportive therapy, surgery (lower 2/3), RT (upper 1/3 & sometimes 2/3), cytotoxic chemotherapy
intraluminal brachytherapy & photodynamic therapy.

Question 8

Describe the surgical procedure for oesopgagial cancer ?

Answer 8

lower 1/3 - oesophagectomy - section removed - large bowel is used to replace the oesophagus
palliative surgery is rare & performed if morbidity is low or a tracheoesophageal fistula is present.

Question 9

when is radical radiotherapy for oesophageal cancer used?

Answer 9

mid/ipper 3rd, tumour less than 5cm, no local or distant spread, under 70yrs, good performance status
5yrs survival of 10% :(

Question 10

using RT how is the tumour localised in planning and what is the target volume?

Answer 10

localisation - CT & endscopic ultrasound
target volume - tumour + 3cm above or below
GTV = 1.5-2cm margin

Question 11

what RT technique is used

Answer 11

single phase 3-field technique, anterior & 2 obligues (avoid spinal cord)
palliative - parallel opposed 1-2cm margin

Question 12

what are dose and # of oesophageal cancer?

Answer 12

radical RT - 45-50Gy in 25#
Chemo-RT - 50Gy in 25# with 5FU
preoperative - 45Gy in 25#
palliative - 30Gy in 10# or 20GY 5# 6MV

Question 13

when and how is brachytherapy used?

Answer 13

relieve dysphagia & bledding

5-20GY delivered through a nasogastric tube

Question 14

what are treatment side effects for oesophageal cancer?

Answer 14

dysphagia, tiredness, dry mouth, weightloss, fungal infection oesophageal strictures