Oesophageal cancer

Question 1

Adenocarcinoma

Answer 1

Most common type in UK/USA

Lower third- near the junction

Risk factors
- GORD
- Barret’s oesophagus
- smoking
- achalasia
- obesity

Question 2

Squamous cell cancer

Answer 2

Most common in developing world

Upper two thirds of oesophagus

Risk factors
- smoking
- alcohol
- achalasia
- Plummer Vinson syndrome
- diets rich in nitrosamines

Question 3

Features

Answer 3

Dysphagia is most common presenting symptom

Anorexia and weight loss

Vomiting

Hoaresness, melaena, cough

Question 4

Diagnosis

Answer 4

Upper GI endoscopy with biopsy

Endoscopic US preferred method for locoregional staging

CT CAP for initial staging

Question 5

Treatment

Answer 5

Operable disease best managed by surgical resection (Ivor-Lewis type oesophagectomy)

Biggest surgical challenge is anastomotic leak with intrathoracic anastomosis resulting in mediastinitis

Adjuvant chemotherapy