Oesophageal Cancer Flashcards
What are the types of oesophageal cancer?
Squamous carcinoma: occurs in proximal and middle thirds of oesophagus
Adenocarcinoma: occurs in distal oesophagus (develops from Barrett’s Oesophagus)
What are the risk factors for squamous carcinoma?
Smoking Alcohol Achalasia Dietary carcinogens Low socio-economic status
What are the risk factors for adenocarcinoma?
Barrett’s metaplasia
Obesity
Male
Caucasian
What is the presentation?
Progressive dysphagia (90%) Anorexia and weight loss (75%) Odynophagia Chest pain Heartburn Cough Pneumonia (trachea-oesophageal fistula) Haematemesis Vocal cord paralysis
How is it diagnosed?
Endoscopy + biopsy
How is it staged?
TNM: EUS, CT, PET CT, bone scan, laparoscopy
What is the prognosis?
5-year survival rate less than 15%: usually presents late, tumours have commonly spread to regional nodes and/or liver at presentation
What is the curative treatment?
Only potential cure is surgical oesophagectomy ± chemotherapy (adjuvant or neoadjuvant)
Who is curative treatment limited to?
Localised disease: T1-2
Without co-morbid disease
Usually <70 yrs
What is the mortality of an oesophagectomy?
10%
What is important post operative (post oesophagectomy)?
Contrast radiology to ensure the joins are okay
Long recovery: return to pre-op QOL in 10 months
Nutritional support
Most patients have incurable disease at presentation. What are some palliative measures undertaken?
Palliative: locally advanced/unfit
Combined chemo and radiotherapy (improve long term survival)
Restore swallowing with chemo/radiotherapy, stenting or endoscopic laser use
What are some local effects of oesophageal cancer?
Obstruction
Ulceration (bleeding)
Perforation
What are methods of spread of oesophageal cancer?
Direct: to surrounding tissues (e.g. lung)
Lymphatic: to regional lymph nodes
Blood: e.g. liver
