Oesophageal carcinoma (brief)

Question 1

Who does it affect?

Answer 1

Adenocarcinoma: ↑ Incidence in Western world. M:F 5:1

Squamous carcinoma: Slightly reducing incidence in western world M:F 3:1

Rhabdomyosarcoma: Malignant tumour of skeletal muscle wall of the oesophagus. Very Rare

Lipoma and gastrointestinal stromal tumour: Rare

Question 2

What causes it?

Answer 2

Adenocarcinoma: Associated with dietary nitrosamines, GORD, and Barret’s metaplasia. Typically occurs in the lower half of the oesophagus

Squamous carcinoma: Associated with smoking, alcohol intake, diet poor in fresh fruit and veg, chronic achalasia, chronic caustic strictures. May occur anywhere in oesophagus

Question 3

How does it present?

Answer 3

Dysphagia (any new symptoms of dysphagia, especially over the age of 45, should be assumed to be cancer until proven otherwise).

Haematemesis, rarely the presenting symptom. Incidental screening, when following up Barrett’s metaplasia, achalasia or reflux disease.

Symptoms of disseminated disease. Cervical lymphadenopathy, hepatomegaly due to mets etc.

Symptoms of local invasion, dysphonia, cough and haemoptysis, neck swelling, horners syndrome.

Question 4

Signs on examination?

Answer 4

Neck swelling

Lymphadenopathy

Question 5

Investigations?

Answer 5

Flexible oesophagoscopy and biopsy.

Barium swallow only indicated for failed intubation or suspected post cricoid carcinoma (often missed by endoscopy).

Question 6

Treatment?

Answer 6

Often palliative. If looking for cure:

Squamous carcinoma: Radical external beam radiotherapy followed by surgery (radical resection)

Adenocarcinoma (large): Neoadjuvant chemoradiotherapy followed by radical resection

Adenocarcinoma (small) or high grade dysplasia in Barret’s: Surgical resection

Question 7

Conditions that would present similarly?

Answer 7

Achalasia

Esophageal stricture from gastroesophageal reflux

Benign esophageal tumours (principally oesophageal leiomyoma)