Oesophageal Cancer Flashcards

1
Q

What are the 2 major histological types of oesophageal cancer?

A

Squamous Cell Carcinoma: upper 2/3rds
Adenocarcinoma: lower 1/3rd near gastroesophageal junction

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2
Q

5 risk factors for squamous cell oesophageal cancer

A

Alcohol
Smoking
Plummer-Vinson syndrome
Diet rich in nitrosamines
Achalasia

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3
Q

List 3 risk factors for oesophageal adenocarcinoma

A

GORD
Barrett’s oesophagus
Smoking
Obesity

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4
Q

Describe the distribution of oesophageal cancer by type

A

M>F
SCC more common in DEVELOPING COUNTRIES
Adenocarcinoma: most common in WESTERN WORLD

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5
Q

What is the most common presenting symtpom of oesophageal cancer?

A

Dysphagia

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6
Q

3 Common Sx of oesophageal cancer

A

Progressive dysphagia (initially worse for solids)
Odynophagia (painful swallowing)
Weight loss

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7
Q

List 3 signs of metastatic disease in oesophageal cancer

A

Supraclavicular lymphadenopathy
Hepatomegaly
Hoarseness

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8
Q

How may oesophageal cancer be missed?

A

Often ASYMPTOMATIC
There may be NO SIGNS

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9
Q

What are the first line investigations in patients with severe symptoms suggestive of oesophageal cancer?

A

Oesophagogastroduodenoscopy (OGD) with biopsy
Metabolic profile: may be very volume depleted + hypokalaemic

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10
Q

What other investigations are performed in patients with oesophageal cancer?

A

CT CAP + PET scan: to stage + identify mets

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11
Q

What is Plummer Vinson Syndrome?

A

Rare disease characterized by difficulty swallowing, IDA, glossitis, cheilosis + esophageal webs.

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12
Q

What may be indicated by cough in oesophageal cancer?

A

Oesophagotracheal or oesophagobronchial fitsula from local invasion by tumour

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13
Q

6 less common Sx of oesophageal cancer

A

Regurgitation
Cough
Choking after food
Voice hoarseness (Recurrent laryngeal N)
Hiccups (phrenic N)
Fatigue (due to IDA)

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14
Q

Tx for oesophageal cancer suitable for surgery

A

Endoscopic resection
OR
Oesophagectomy
Post-op: Nivolumab

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15
Q

Tx for oesophageal cancer not suitable for surgery/ additional medical management

A

Chemoradiotherapy: Cisplatin + Fluorouracil

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16
Q

What is the biggest surgical challenge of treating oesophageal cancer?

A

Anastomotic leak, with an intrathoracic anastomosis resulting in mediastinitis