The Oesophagus - Oesophageal Carcinoma

Question 1

Types of Oesophageal Carcinoma (2).

Answer 1

1. Adenocarcinoma (now - commonest).

2. Squamous Cell Carcinoma (previously - commonest).

Question 2

Distribution of Oesophageal Cancers (2).

Answer 2

1. SCC - Upper 2/3 of Oesophagus.

2. Adenocarcinoma - Lower 1/3 of Oesophagus.

Question 3

Risk Factors of Adenocarcinoma (5).

Answer 3

1. GORD.
2. Barrett’s Oesophagus.
3. Smoking.
4. Achalasia.
5. Obesity.

Question 4

Risk Factors of SCC (5).

Answer 4

1. Smoking.
2. Alcohol.
3. Achalasia.
4. Plummer-Vinson Syndrome
5. Diet rich in Nitrosamine, Areca or Betel Nuts.

Question 5

Clinical Presentation of Oesophageal Cancer (4).

Answer 5

1. Progressive Dysphagia - commonest (solids to liquids) - due to progressive obstruction of the lumen.
2. Constitutional Symptoms.
3. Vomiting.
4. Odynophagia, Hoarseness, Melaena, Cough.

Question 6

Investigations of Oesophageal Cancer (3).

Answer 6

1. Upper GI Endoscopy + Biopsy = Diagnosis.
2. Locoregional Staging - Endoscopic US.
3. CT TAP - Initial Staging (FDG-PET CT - Occult Metastases).

Question 7

Management of Oesophageal Cancer (2).

Answer 7

1. Operable Disease - Surgical Resection : Ivor-Lewis Type Oesophagectomy.
2. Adjuvant Chemotherapy.

Question 8

Complication of Oesophageal Surgery.

Answer 8

Anastomotic Leak - Intrathoracic Anastomosis can result in Mediastinitis.

Question 9

Prognosis of Oesophageal Cancer.

Answer 9

Very poor prognosis - 5-10% survival at 5 years because the tumour is usually high-stage at presentation.