Oesophageal cancer (GI) Flashcards
(28 cards)
Describe the epidemiology of oesophageal cancer. (2)
- M>F
- 60-70 years old
What are the two types of oesophageal cancer?
- squamous cell carcinoma (upper 2/3)
- adenocarcinoma (lower 1/3)
What are the risk factors for oesophageal squamous cell carcinoma? (7)
- alcohol
- smoking
- diet low in fruit and veg
- hot beverages
- HPV
- achalasia
- Plummer-Vinson syndrome
What are the risk factors for oesophageal adenocarcinoma? (5)
- obesity
- male
- GORD –> Barrett’s oesophagus
- Barrett’s oesophagus
- hiatus hernia (increased reflux)
Smoking and alcohol intake not as important as they are for SCC - instead factors that increase reflux more important
Which type of oesophageal cancer is more common in the developed world?
Adenocarcinomas
Describe the development of oesophageal cancer - adenocarcinoma.
- GORD –> Barrett’s oesophagus
- Barrett’s oesophagus = metaplasia of mucosal lining of distal oesophagus due to long-standing reflux
- stratified squamous epithelium replaced by abnormal columnar epithelium
- metaplasia –> dysplasia –> malignant
What are oesophageal cancers usually like at time of diagnosis?
Locally advanced
Dysphagia (presenting Sx) only occurs after obstruction of >2/3 of the lumen
What are the main clinical features of oesophageal cancer? (3)
- progressive dysphagia - first solids, then liquids
- odynophagia
- rapid weight loss (due to both lack of intake + cancer itself)
What are the signs of advanced oesophageal cancer? (4)
- hoarseness - recurrent laryngeal nerve pressed
- Horner’s syndrome - ptosis, miosis, anhidrosis
- hiccups - phrenic nerve involvement
- postprandial/paroxysmal cough - oesophago-tracheal/bronchial fistula from local invasion
What are the features of Horner’s syndrome? (3)
- ptosis - droopy eyelid
- miosis - constricted pupil
- anhidrosis - little/no sweat
What signs of upper GI bleeding could there be in oesophageal cancer? (4)
- haematemesis
- melaena
- raised urea
- Sx of anaemia (fatigue, SOB)
Raised urea –> upper GI bleed
What might you see on examination in oesophageal cancer? (2)
- supraclavicular lymphadenopathy
- hepatomegaly - metastatic disease
What are the first-line investigations for oesophageal cancer? (4)
- OGD with biopsy
- EUS +/- FNA
- CT thorax and abdomen
- FDG-PET scan
What is the gold standard investigation for oesophageal cancer?
Upper GI endoscopy (OGD) with biopsy - 1st line in dysphagia, odynophagia and weight loss patients
Differentiates oesophageal cancer from benign causes of dysphagia e.g. achalasia
How do we stage oesophageal cancer?
CT CAP/MRI - important for treatment
What are some differential diagnoses for oesophageal cancer? (3)
- benign stricture
- Barrett’s oesophagus
- achalasia:
- regurgitation w/o heartburn
- may be clinically indistinguishable
- bird’s beak filling defect in upper GI series
- dysphagia of both solids and liquids
- manometry
How do we manage low grade dysplasia (oesophageal cancer)?
High dose PPI
Six-monthly endoscopic surveillance
How can we manage superficial intramucosal well-differentiated oesophageal cancer?
Oesophagus-sparing approach - endoscopic mucosal resection +/- ablation and surveillance
What is the management for locally advanced oesophageal cancer?
Combined modality therapy: chemotherapy/chemoradiotherapy followed by oesophagectomy
What main management is there for oesophageal cancer apart from surgical management?
Chemoradiotherapy - better than radiotherapy alone
What are some complications of oesophageal cancer? (4)
- post-operative pneumonia
- aspiration pneumonia
- post-resection oesophageal reflux
- fistula
Describe the prognosis of oesophageal cancer.
Lethal malignancy - poor prognosis due to aggressive course and late diagnosis
What is achalasia (oesophageal cancer differential)?
Incomplete relaxation of lower oesophageal sphincter –> hypomotility
How does achalasia present (similar to oesophageal cancer)?
Dysphagia to both solids and liquids from start
(Oesophageal cancer = progressive with solids then liquids)
