Oesophageal cancer Flashcards
What is oesophageal cancer
originates from epithelial lining of oesophagus
What are the2 types of oesophageal cancer
Squamous - upper 2/3rd
Adenocarincoma – 1/3
What is the epidemiology of squamous oesophageal cancer
more common in developing world
associated with smoking and excessive alcohol consumption
What is the epidemiology of adenocarcinoma
more common in developed world
arises as consequence of Barrett’s oesophagus which then leads to dysplasia
Associated with long standing GORD, obesity and high fat intake
What would someone with oeosphageal cancer present with
short history of dysphagia - solids to liquids
weight loss
chest pain
hoarseness- if recurrent laryngeal nerve is pressed
dyspepsia
ALARM symptoms
What may physical examination reveal
lymphadenopathy or sins of metastatic disease
What is the criteria for a 2 week wait urgent upper GI endoscopy
Any patient with dysphagia OR any patient >55 with weight loss and upper abdominal pain,dyspepsia or reflux
What are investigations for oesophageal cancer
OGD with biopsy
if OGD cannot be tolerated then barium swallow
What investigations should be used to stage cancer and assess for metastatic disease
CT chest abdomen and pelvis- fully investigate nodal spread
Endoscopic ultrasound- best for T staging and local N staging
PET- can identify distal metastases including lymph nodes that may appear normal size on CT
What is the management for oesophageal cancer
- Surgery for early stage
radical oesophagectomy
endoscopic techniques - mucosal resection
-Chemo and radio used in combination with surgery/palliative care for advanced disease
-Paliative care to improve QoL and relieve symptoms
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What can be used to relieve the symptoms associated with oeosphageal cancer
Radiological insertion of expansion esophageal stent
Laser treatment to esophageal lesion– can control symptoms for a short time
What is treatment for limited disease
T1a - endoscopic therapy alone then maybe oeosphagectomy if not effective
T1b - surgery , if unsuitable/decline chemo , if decline then palliative
What is treatment for localised disease
oeophagectomy - pre/post chemo
low risk - surgery alone
high risk squamous - surgery and preoperative chemo
high risk adenocarcinoma - surgery and pre/post op chemo
decline surgery/unsuitable - definitive chemo
What is the treatment for locally advanced disease
multimodality treatment
What are some associated complications
aspiration pneumonia
fistulae
