Oesophageal Cancer

Question 1

Define oesophageal cancer

Answer 1

Malignant tumour arising from oesophageal mucosa

Question 2

What are the causes/risk factors of oesophageal cancer?

Answer 2

Squamous carcinoma (upper 2/3)
• Smoking
• Alcohol
• HPV
• Achalasia
• Plummer-Vinson syndrome
• Scleroderma
• Coeliac disease
• Dietary nitrosamines e.g. cured
meats, salted fish, pickled
vegetables

Adenocarcinoma (lower 1/3)
• GORD
• Hiatus hernia
• Obesity
• Barrett’s oesophagus (0.3%/year or 3 in 1000 per year)

Question 3

What are the symptoms of oesopahgeal cancer?

Answer 3

• Reflux
• Dysphagia
• Regurgitation
• Odynophagia
• Weight loss
• Fatigue
• Voice hoarseness (recurrent laryngeal nerve palsy)
• Postprandial/paroxysmal cough
• Hiccups

Question 4

What are the sign of oesophageal cancer?

Answer 4

• Lymphadenopathy/ metastases

Question 5

What investigations are carried out for oesophageal cancer?

Answer 5

• OGD with biopsy -mucosal lesion; histology shows squamous carcinoma or adenocarcinoma
• comprehensive metabolic profile - advanced cases: hypokalaemia, elevated creatinine and serum urea/nitrogen
• CT thorax and abdomen - indicates size of primary tumour, local invasion, and presence or absence of metastases
• MRI thorax and abdomen - indicates size of primary tumour, local invasion, and presence or absence of metastases
• FDG-PET scan - hyperactivity (hot spot) at primary tumour site and locoregional disease; may also show activity in lungs, liver, or bones suggestive of metastases
• endoscopic ultrasound (EUS) ± fine needle aspiration (FNA) - indicates extent of local invasion and presence or absence of spread to lymph nodes
• bronchoscopy ± fine needle aspiration (FNA) - normal or may show involvement of tracheobronchial tree
• thoracoscopy and laparoscopy - may reveal metastatic disease
• pulmonary function tests - normal or reduced
• cardiac stress test - normal or may show cardiac abnormality
• echocardiogram - normal or may show cardiac abnormality