Esophageal cancer Flashcards Preview

General surgery > Esophageal cancer > Flashcards

Flashcards in Esophageal cancer Deck (18):
1

Risk factors

Diet
Alcohol
Smoking
Achalasia
Plummer vinson syndrome
Obesity
Low vitamin A and C
Nitrosamine
Reflux
Barretts
Male

2

Location

Most common in middle 50%
Upper 20%
Lower 30%

3

Type

Adenocarcinoma
SCC

4

Clinical features

Dysphagia
Weight loss
Retrosternal chest pain

Hoarseness, cough

5

Investigations

1. Oesophagoscopy w/ biopsy
2. USS
3. CT/PET CT
Barium swallow
CXR
Staging laparoscopy if significant infra-diaphragm component

If limited food intake must assess nutritional status
1. UEC
2. LFTs, albumin, iron/folate

6

Management

1. Non-operative
Stenting, ablation, polypectomy, phototherapy
Neoadjuvant chemoradiation: cisplatin + 5FU
2. Operative
Lewis tanner: intrathoracic esophagogastric anastamosis
Transhiatal
Esophagectomy
3. Nutritional management
If required feeding access

7

Contraindications to operative

Metastasis
Infiltration of tracheal/bronchial/aorta

8

Risk analysis for surgery

++Cardiopulmonary statu
Must cease smoking
Chest physioT
Optimise nutrition

9

Complications of operative management

1. Medical
Cardiac- Failure, MI, arrythmias
Respiratory- sputum retention, bronchopneumonia, effusion, PE, pneumothorax, atelectasis
Hepatic/renal failure, stroke
2. Surgical
Hemorrhage
Fistula
Stricture
Obstruction
Tracheo-bronchial damage
Leak
Herniation
Infection
Empyema
Abscess

10

Staging and options for management

T0 CIS
T1 Invading lamina P/submucosa
T2 muscularis propria
T3 Adventitia
T4 Invasion adjacent

N0 none
N1 regional nodes

M0 none
M1 mets

Stage 1-2 Resectable->radical esophagectomy
Stage 3 Locally advanced not resectable: chemoradiation with Epirubicin, cisplatin and 5FY
Stage 4/Mets: Palliation->Stent, chemoT, brachyT, phytoT

11

Is adenocarcinoma increasing

Yes->increase in GORD and barretts

12

Siewart classification of GE junction adenocarcinomas and surgical treatment

1. Type I tumors are located more than 1 cm above the GE junction (surgical treatment would generally consist of esophagectomy)
2. type II tumors are located within 1 cm proximal and 2 cm distal to the GE junction (surgical treatment would consist of esophagectomy with partial resection of the proximal stomach)
3. Type III tumors are located more than 2 cm distal to the GE junction (surgical treatment would consist of total gastrectomy).

13

5 year survival

Stage 1 75-80
Stage 2 35-40
Stage 3 10-15
Stage 4 0

14

Stent advantage and disadvantage

1. Advantages: Rapid relief of dysphagia; treatment of choice for tracheoesophageal fistula; short procedural time; outpatient procedure
2. Disadvantages: Recurrence due to stent migration, tumor overgrowth, food impaction; transient pain following placement; gastroesophageal reflux; and increased risk of late hemorrhage

15

Phtodynamic therapy advantages and disadvantages

Endoluminal destruction of obstructing lesions
1. Advantages: Works well with exophytic lesions; generally low complication rates
2. Disadvantages: Often available only in specialized centers; special expertise required; repeat treatment every 4-8 weeks is needed

16

Brachytherapy advantages and disadvantages

Intraluminal radiotherapy
1. Advantages: Long-term dysphagia improvement is better than stent placement; long-term quality-of-life score was better when compared with stent placement; lower rate of hemorrhage than stent placement
2. Disadvantage: Dysphagia relief is delayed in comparison to stent placement

17

Chemotherapy advantages and disadvantages

1. Advantages: Treatment improves median survival; responders may have improved quality of life due to relief of obstruction
2. Disadvantages: Response to obstruction is variable; therefore, additional treatment for obstruction may be needed; relief from obstruction may be delayed

18

Risk factors of SCC

Tobacco
Alcohol
Chemical burns