OESOPHAGEAL CANCER Flashcards Preview

ONCOLOGY AND PALLIATIVE CARE > OESOPHAGEAL CANCER > Flashcards

Flashcards in OESOPHAGEAL CANCER Deck (27):
1

What are the two main types of oesophageal cancer?

Adenocarcinoma
Squamous cell carcinoma

2

Where are most cancers of the oesophagus found?

Lower 2/3rds with 50% occurring in the lowest third

3

What percentage of diagnosed cancers do oesophageal carcinomas represent?

5%

4

What is the sequence of pathology in the development of oesophageal adenocarcinoma?

GORD
Barrett's oesophagus
Invasive adenocarcinoma

5

What are the oncogenes involved in the development of adenocarcinoma of the oesophagus? Which chromosome are these mutations found on?

p53
LOH

Both on chromosome 17

6

What percentage of patient's with Barrett's oesophagus go on to develop adenocarcinoma of the oesophagus?

About 10%

7

Where are carcinomas of the oesophagus most likely to spread to?

Local spread:
Length of oesophagus
Pleura
Trachea
Bronchi
Lung
Aorta

Distant metastases via haematogenous or lymphatic spread:
Liver
Lung

8

Are most oesophageal cancers squamous in nature or adenocarcinomas?

90% are squamous cell carcinomas

9

Where is the world is oesophageal cancer most commonly seen?

China

10

Is oesophageal cancer more common in men or women?

Men

11

What are the risk factors for developing oesophageal cancer?

Smoking
Alcohol
GORD

Rarer:
Achalasia (muscles of the lower part of the oesophagus fail to relax)
Plummer-Vinson syndrome (dysphagia, iron deficiency anemia, and oesophageal webs)
Tylosis (thickening of the skin in the palms of the hands and the soles of the feet)

12

How might someone with suspected carcinoma of the oesophagus present?

50-80 years old
Dysphagia
Weight loss
Fatigue - anaemia
Vomiting
Haematemesis
Haemoptysis
Pain on swallowing (odynophagia)
Hoarse voice

May present with cough and dyspnoea - due to aspiration

13

What investigations would you order in someone with suspected oesophageal cancer?

FBC
LFTs
U&Es
Endoscopy
Barium swallow - for those who cannot tolerate endoscopy
Endoscopic ultrasound and spiral CT - for staging of disease
PET scan or PET/CT

14

Why would you do LFTs in someone with suspected oesophageal cancer?

Thinking about metastatic spread

15

Why would you do U&Es in someone with suspected oseophageal cancer?

Dehydration due to dysphagia

16

What three ways might a cancer of the oesophagus be described from endoscopy?

Protruding - 60%
Excavating - 25%
Flat - 15%

17

What is the staging process used for oesophageal cancers?

TNM

18

What does T1 mean with regard to oesophageal cancer staging using the TNM system?

Tumour invades lamina propria or submucosa

19

What does T2 mean with regard to oesophageal cancer staging using the TNM system?

Tumour invades muscularis propria

20

What does T3 mean with regard to oesophageal cancer staging using the TNM system?

Tumour invades adventitia

21

What does T4 mean with regard to oesophageal cancer staging using the TNM system?

Tumour invades adjacent structures

22

What does N0 mean with regard to oesophageal cancer staging using the TNM system?

No lymph node involvement

23

What does N1 mean with regard to oesophageal cancer staging using the TNM system?

Confined to local nodes

24

What does N2 mean with regard to oesophageal cancer staging using the TNM system?

More distant node involvement but still specified for that tumour type. Otherwise classified as M for metastatic.

25

What is the prognosis for someone diagnosed with oesophageal cancer?

Exceptionally poor - 2-5% survival rate at 5 years

26

What are the treatment options for someone diagnosed with oesophageal cancer?

MDT
Surgery - only possible cure
Radiotherapy - reduces size of tumour, relieves dysphagia
Laser therapy - relieves dysphagia
Endoscopic placement of expanding metal stent
Brachytherapy - radioactive implants

27

What is the operative mortality rate for surgical removal of oesophageal malignant tumour?

5-10%