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2017 CSB032 Radiation Therapy 2 > Oesophageal Cancer > Flashcards

Oesophageal Cancer Flashcards

(43 cards)

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1
Q

What is the definition of Aetiology

A

The study of a cause of a disease/ illness

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2
Q

What is the definition of Epidemiology

A

A branch of medicine that deals with the incidence, control and distribution of diseases

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3
Q

What are two types of oesophageal cancer

A

Adenocarcinoma and Squamous Cell Carcinoma

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4
Q

Describe the INCIDENCE of oesophageal cancer

A 
2.2% of all cancers 
6th cause of cancer death worldwide 
5 year survival is less than 25% 
It is rarely seen in people below 25
It peaks in individuals 60-70
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5
Q

What are risk factors of squamous cell oesophageal cancer?

A 
Tobacco and Alcohol
Diet
Achalasia
Head and Neck Cnacer 
Tylosis, Coeliac disease and Lye ingestion
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6
Q

What are risk factors of adenocarcinoma oesophageal cancer?

A

Barrett’s oesophagus
Chronic reflux
Smoking
Obesity

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7
Q

Endemic Oesophageal cancer

A

?

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8
Q

Endemic Oesophageal cancer

A

?

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9
Q

What is some basic anatomy of the oesophagus?

A

runs from cricoid cartilage to O-G junction
Average length is 25cm
Split into 2 parts: Cervical and Thoracic
Outer layer is longitudinal muscle
Inner layer is circular muscle

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10
Q

OESPHAGEAL LYMPH NODES

A

see slide 8

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11
Q

What is the natural history (prognosis) of oesophageal cancer

A

90% dead within 5yrs
30% present with localised disease, 40-50% operable
Local relapse most common problem (SCC)
Systemic spread also a problem

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12
Q

What is the most common route of spread?

A

Sub-mucosal spread is most common.

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13
Q

Where can CERVICAL oesophageal cancer spread to?

A

Cervical oesophagus can spread to: carotids, pleura, recurrent laryngeal nerve, treachea

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14
Q

Where can MIDDLE THIRD oesophageal cancer spread to?

A

bronchi, thoracic duct, aortic arch, azygos vein, right pleura

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15
Q

Where can LOWER THIRD oesophageal cancer spread to?

A

Pericardium, left pleura, descending aorta

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16
Q

What are symptoms of Oesophageal cancer?

A 
Dysphagia- difficulty swallowing
Anorexia 
Weight loss
Pain
Vomiting 
Symptoms dependent on location of tumour
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17
Q

How is Oesophageal cancer diagnosed?

A 
Endoscopy
Barium swallow 
Histology
Panendoscopy
Laparoscopy
PET/CT
CT Scan 
Endoscopic ultrasound
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18
Q

Why is staging important?

Study These Flashcards
A

To define the extent of the primary lesion
To exclude metastatic disease
To quantify co-morbidity and assess suitability for therapy

19
Q

Describe Stage 1 of oesophageal cancer?

Study These Flashcards
A

T0 N0 M0

60% chance of 5 year survival

20
Q

Describe Stage 2 of oesophageal cancer?

Study These Flashcards
A

T2-3,N0 M0

31% of 5 year survival

21
Q

Describe Stage 3 of oesophageal cancer?

Study These Flashcards
A

T3 N1 M0

20% chance of 5 year survival

22
Q

Describe Stage 4 of oesophageal cancer?

Study These Flashcards
A

any T, any N, MI

4% chance of 5 year survival

23
Q

What is the histology of oesophageal cancer?

Study These Flashcards
A

50% are squamous cell carcinomas
48% are Adenocarcinomas

The other 2% include: leiomyo-sarcoma, carcinoid, lymphoma, small cell carcinoma

24
Q

What are curative techniques for oesophageal cancer?

Study These Flashcards
A

Surgery
Radiation Therapy
Combined therapy
- CT/RT

25
What is the ideal for of treatment?
surgery - resecting the tumour.
26
What are some reasons for surgical failures
``` high frequecny of nodal involvment spread to surronding organs Advanced at presentation (because it asymptomatic) Patient is medically unfit for surgery Patient refuses surgery ```
27
What is the survival rate for surgery?
5 year survival rate 15-39% | Surgical mortality 4-10%
28
How is the CERVICAL oesophagus treated?
The surgery for cervical oesophageal cancer is quite radical and involves removing the pharynx (loss of voice) thus chemo and radiation are the most common treatments. Treated like a Head and Neck cancer (shell) Overall survival @ 10 years 27%
29
What are the disadvantages SOLE Radiation therapy of oesophageal cancer
Local control limited by normal tissue constraints Longer duration of treatment leads to more adverse symptoms 9% 2 year Survival rate 6% 5 year Survival rate
30
Who are the ideal candidates for chemo/radiation therapy
people with localised disease (who arent fit for surgery) localised SCC - Very small tumours people with upper third lesions
31
Is concurrent CT/RT better that just RT
For Ct/RT the local recurrence is reduced by 12% (when compared to just RT) However the toxicity is increased by 17%
32
Is surgery after CT/RT a good idea
The chance of surgical morbidity is increased. However local control (from the CT/RT) is improved. Their are also fewer interventions required for dysphagia (difficulty swallowing) Overall the survival chance is equal
33
What are the goals of palliative treatment in oesophageal cancer?
restore or maintain swallowing Manage pain Prevent bleeding
34
Who are the ideal candidates for palliation
people with local symptoms and distant metastatic disease People with inadequate respiratory function Patients with a poor performance status Patients with very large tumours
35
What are methods of palliative treatment
``` Radiation therapy -EBRT, Brachytherapy, Chemotherapy- no evidence of benefit Stenting LASER ```
36
Why is the simulation/ CT stage important
important for: delineation of GTV lung DVH's Spinal cord delineation
37
What immobilisation devices are used
oesophageal board - arms up head and neck shell- for cervical oesophagus Orfit
38
What are the planning margins for oesophageal cancer?
GTV= gross tumour volume CTV= GTV plus 2 -2.5 cm margin radially 3-4cm sup&inferior PTV= CTV plus 0.7cm
39
What are the usual field arrangements for oesophageal radiation.
ANT, POST, LEFT LAT, RIGHT LAT ANT, POST and obliques for palliative- Parallel opposed
40
What are common dose fractionations
Radical CT/RT - 50.4 Gy/1.8-2.0 fractions Radiation (SOLE MODALITY) - 60-66 gy Palliation - RT alone 35-45 Gy/15-25# TROG trial: 45Gy/15#/cisplatin/5FU
41
What are organs at risk with the oesophagus
Lung - anything that receives more than 20Gy is destroyed limit the vlume of lung receiving more than 20Gy to 30-35% Spinal cord limited to more than 46GY @2gy fractions Cervical oesophagus may allow 50Gy/30# to cord
42
What are acute side effects of treatment
``` Lethargy Skin erythema Dysphagia - difficulty swallowing Odynophagia - painful swallowing Risk of neutrpaeni sepsis Percarditis - inflammation of pericardium ```
43
What are late side effects of treatment
pulmonary fibrosis second malignancy Hypothyroidism- under active thyroid Increased risk IHD- ischaemic heart disease Benign stricture- narrowing of oesophagus

2017 CSB032 Radiation Therapy 2 (6 decks)

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