Oesophageal Cancer Flashcards
What are the 2 major histological types of oesophageal cancer?
Squamous Cell Carcinoma: upper 2/3rds
Adenocarcinoma: lower 1/3rd near gastroesophageal junction
5 risk factors for squamous cell oesophageal cancer
Alcohol
Smoking
Plummer-Vinson syndrome
Diet rich in nitrosamines
Achalasia
List 3 risk factors for oesophageal adenocarcinoma
GORD
Barrett’s oesophagus
Smoking
Obesity
Describe the distribution of oesophageal cancer by type
M>F
SCC more common in DEVELOPING COUNTRIES
Adenocarcinoma: most common in WESTERN WORLD
What is the most common presenting symtpom of oesophageal cancer?
Dysphagia
3 Common Sx of oesophageal cancer
Progressive dysphagia (initially worse for solids)
Odynophagia (painful swallowing)
Weight loss
List 3 signs of metastatic disease in oesophageal cancer
Supraclavicular lymphadenopathy
Hepatomegaly
Hoarseness
How may oesophageal cancer be missed?
Often ASYMPTOMATIC
There may be NO SIGNS
What are the first line investigations in patients with severe symptoms suggestive of oesophageal cancer?
Oesophagogastroduodenoscopy (OGD) with biopsy
Metabolic profile: may be very volume depleted + hypokalaemic
What other investigations are performed in patients with oesophageal cancer?
CT CAP + PET scan: to stage + identify mets
What is Plummer Vinson Syndrome?
Rare disease characterized by difficulty swallowing, IDA, glossitis, cheilosis + esophageal webs.
What may be indicated by cough in oesophageal cancer?
Oesophagotracheal or oesophagobronchial fitsula from local invasion by tumour
6 less common Sx of oesophageal cancer
Regurgitation
Cough
Choking after food
Voice hoarseness (Recurrent laryngeal N)
Hiccups (phrenic N)
Fatigue (due to IDA)
Tx for oesophageal cancer suitable for surgery
Endoscopic resection
OR
Oesophagectomy
Post-op: Nivolumab
Tx for oesophageal cancer not suitable for surgery/ additional medical management
Chemoradiotherapy: Cisplatin + Fluorouracil
