Esophageal Neoplasms Flashcards Preview

Gen Med: GI > Esophageal Neoplasms > Flashcards

Flashcards in Esophageal Neoplasms Deck (15):

Risk factors for esophageal neoplasm?

Smoking/chew & Alcohol
Barrett’s esophagus
Corrosive-induced esophageal strictures (Lye ingestion)
Other head, neck, chest cancers (Hx of radiation Tx for other conditions in chest)
Poor diet


Pathophysiology of esophageal neoplasms?

1. Chronic irritation leads to histologic changes in esophageal tissue:
A. Chronic tobacco, alcohol use, reflux
B. Inflammation 2° to Barrett’s esophagus, stricture or achalasia


What are the two types of esophageal cancer?

1. SCC
2. Adenocarcinoma


SCC characteristics

↑ w/tobacco, ETOH, poor diet
Proximal 2/3 of esophagus
Arise from epithelial cells


Adenocarcinoma characteristics

↑ w/ Barrett’s esophagus (30-fold risk), tobacco, obesity
Distal 1/3 of esophagus
Arise from glandular cells


Signs & Sx's of esophageal neoplasms?

1. Solid food dysphagia
A. >90% progression over weeks-months
2. Weight loss
3. Odynophagia
4. Coughing on swallowing
A. Suggests invasion into tracheobronchial tree
5. Chest or back pain
A. Suggests mediastinal invasion
6. Hoarseness
A. Recurrent laryngeal nerve involvement
7. Supraclavicular or cervical lymphadenopathy
A. Indicative of mets


Diagnostic Studies for Esophageal Neoplasms

1. Upper Endoscopy
A. Confirms diagnosis
B. Biopsy for histologic Dx
2. CT Chest & Abd/Pelvis / PET scan
A. Used for staging & helps determine Tx
B. Look for lung or liver mets, lymphadenopathy & local tumor extension
- Predictors for poor prognosis
(Mediastinal spread & lymph node involvement)
- Lab tests are nonspecific
(+/- anemia, ↑ LFT’s if liver mets, ↑ Alk Phos if bone mets)


Stage 0

Abnormal cells in mucosa
High cure rate
Surgery (resection) w/ or w/o chemo-radiation Tx
Chemo + radiation w/o surgery


Stage 1

Cancer formed & spread to submucosa
High cure rate
Surgery (resection) w/ or w/o chemo-radiation Tx
Chemo + radiation w/o surgery


Stage II (A & B)

Stage II A: Involves esophageal muscle
Stage II B: Involves any of the first 3 layers of esophagus & nearby lymph nodes
Fit patients
Pre-op chemo-radiation Tx , then resection


Stage III

1. Involves outer esophageal muscle wall & adventitia
2. May involve tissues or lymph nodes near esophagus
Fit patients
Pre-op chemo-radiation Tx , then resection


Stage IV (A & B)

1. Stage IV A: Involves nearby or distant lymph nodes
2. Stage IV B: Involves distant lymph nodes &/or other organs


Therapy for incurable disease: Stages III & IV

1. Not surgical candidate
2. Palliative care
A. Radiation Tx, chemotherapy or both
- 5-FU + Cisplatin
- Docetaxel (2nd -line)


Goals of therapy for incurable disease

1. Relieve dysphagia & pain
A. Wire stent
2. Optimize quality of life
A. Feeding tube placement
3. Minimize treatment side effects



Local spread to mediastinum is common

Overall 5-yr survival rate for esophageal cancer is < 20%