Oesophageal cancer

Question 1

What is oesophageal cancer?

Answer 1

Most oesophageal cancers are mucosal lesions but originate in the epithelial cells lining the oesophagus.

Question 2

What are the two main histological types of oesophageal cancer?

Answer 2

Squamous cell carcinoma

Adenocarcinoma

Question 3

Aetiology of oesophageal cancer

Answer 3

Important factors implicated in the development of oesophageal adenocarcinoma include:
- GORD and Barrett’s oesophagus
-High BMI
-Male sex
- Diets high in total fat and saturated fat
Important factors implicated in the development of oesophageal squamous cell carcinoma include:
- Tobacco smoking
- Alcohol consumption
-HPV

Question 4

Pathophysiology of oesophageal cancer

Answer 4

• It arises in the mucosa and it progresses locally to invade the submucosa and muscular layer.
• It may invade contiguous structures such as the tracheobronchial tree, aorta, recurrent laryngeal nerve
• Metastasis typically occurs to the peri-oesophageal lymph nodes, liver and lungs.

Question 5

Signs and symptoms of oesophageal cancer

Answer 5

Dysphagia (odynophagia) 
Weight loss 
Hoarseness 
Hiccups (uncommon) 
Post-prandial/ paroxysmal cough (uncommon)

Question 6

Risk factors of oesophageal cancer

Answer 6

Male sex
Tobacco use 
Alcohol use 
GORD and Barrett's oesophagus 
Hiatus hernia
FHx of the oesophageal, stomach, oral or pharyngeal cancer

Question 7

Investigations for the diagnosis of oesophageal cancer

Answer 7

OGD with biopsy

Comprehensive metabolic profile ( advanced cases- hypokalaemia)

Question 8

Differentials of oesophageal cancer

Answer 8

Benign stricture
Achalasia
Barrett’s oesophagus

Question 9

Management of oesophageal cancer

Answer 9

TNM staging important using CT 
Stage 0 and 1a: 
Endoscopic resection with or without ablation 
Stage 1, 2and 3:
Oesophagectomy (1st line)
Chemo/radiotherapy (2nd line)
Stage 4: Chemotherapy