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FRCR2 > oesophagus > Flashcards

oesophagus Flashcards

1
Q

How long is the oesophagus, and at what lengths are the key structures

A

15-40cm from central incisors to GHOJ
18cm: sternal notch
25cm: carina
40cm: GOJ

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2
Q

What are the risk factors for oesophageal adenoca

A

Typically distal oesophagus

GORD
Obesity
Reflux & Barretts

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3
Q

What are the risk factors for oesophageal SCC

A

Typically proximal oesophagus
Alcohol, smoking

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4
Q

What are the investigations for a potential oesophageal cancer

A

Assess local disease:
OGD & biopsy
EUS for nodal assessment
+/- bronchoscopy if threat of tracheal invasion / involvement

Assess distant disease:
CTCAP
PET (if considering radical treatment)
Laparoscopy to exclude peritoneal mets (in GOJ or T3/4 tumours)

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5
Q

What is the frequency of follow up OGD for surveillance of dysplasia on biopsy

A

No dysplasia: OGD every 2-3 years
LG dysplasia: OGD every 6 months
HG dysplasia: discuss in MDT – resect vs surveillance

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6
Q

What molecular markers are sent for a new oesophageal cancer

A

PDL1, MMR and HER2
PDL1 - CPS >10, or TPS >1%

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7
Q

How is a T1 oesophageal cancer defined

A

Invasion into mucosa

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8
Q

How is a T2 oesophageal cancer defined

A

Muscular invasion - muscularis propia

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9
Q

How is a T3 oesophageal cancer defined

A

Invasion into adventitia

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10
Q

How is a T4 oesophageal cancer categorised and defined

A

Resectable local invasion - 4a - pleura, pericardium, diaphragm, peritoneum
Non-resectable local invasion - 4b - aorta, trachea vertebrae

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11
Q

How is nodal staging defined for oesophageal cancer

A

N1 - 1-2 nodes
N2 - 3-6 nodes
N3 - ≥7 nodes

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12
Q

When is endoscopic surgery indicated for oesophageal cancer

A

T1N0 disease, and <2cm, <1/3 oesophageal circumference, non-ulcerated, well diff cancer

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13
Q

What is the treatment regime for a T2-4 or node positive oesophageal adenocarcinoma

A

Neoadjuvant FLOT x4 cycles, followed by surgery

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14
Q

What is the regimen for neoadjuvant CRT for oesophageal SCC or adenocarcinoma

A

Weekly carboplatin (AUC2)/paclitaxel (50mg/m2) x5 with 41.4Gy/23# RT

CROSS trial demonstrated improved R0 resection and benefit in mOS (SCC better than adeno)

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15
Q

What are the types of oesophagectomy and when are they indicated

A

2 stage - Ivor-Lewis, with en bloc two field lymphadenectomy - for mid/lower 1/3 oesophageal cancer
3 - stage - McKeown - for proximal cancers

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16
Q

When is definitive CRT for oesophageal cancer indicated

A

Surgery is SOC

CRT indicated if:
Pt declines surgery
Pt not fit for surgery
Local disease precludes, ie unlikely to achieve an R0 resection

17
Q

What is the chemoRT regimen for oesophageal cancer
How does CRT compare to surgery

A

4 cycles of 3wkly cisplatin (75mg/m2 - D1) & 5FU (1000mg/m2 - D1-4)
OR 3wkly cisplatin (60mg/m2 - D1) & bd capecitabine (625mg/m2) throughout treatment

RT given with cycles 3 & 4
50Gy/25# (or 50.4Gy/28#)

Local control rates better with surgery, but equivalent overall survival
ESOPEC trial is investigating neoadjuvant FLOT vs CRT

18
Q

When is adjuvant nivolumab indicated for oesophageal cancer
What was the benefit

A

Only following trimodality treatment, ie chemoRT and surgery, where there is residual disease on pathology, either for SCC or adeno

1yr adjuvant nivolumab, no PDL1 status needed

Improved DFS from 11mths to 22.4 and reduction in risk of death

19
Q

When is radical RT alone indicated and what is the dose

A

when not fit for surgery or CRT

Dose:
If <5cm - 50Gy/16#
If >5cm - 55Gy/20#

20
Q

What is the maximal oesophageal tumour length that can be treated with RT

A

17cm - 10-12cm tumour and nodes, + margin

21
Q

What is the GTVp & GTVn

What is the GTV-CTV margin and what else is included in the CTV?

What is the CTV-PTV margin

A

GTVp - Tumour + nodes within 3cm
GTVn - nodes >3cm from primary

CTV - GTVp +2cm sup/inf, or GTVn +1cm (whichever is greater), then 1cm radially
If GOJ involvement - extend CTV to 2cm below GTV
CTV also includes elective nodal regions, gastrohepatic ligament, paracardial and left gastric LNs

CTV-PTV margin - 1cm sup/inf & 0.5cm radially

22
Q

What are the OAR dose constraints for oesophageal RT

A

Lungs – combined DVH - V20Gy < 25%
Heart - V40Gy < 30%
Spinal cord - Vmax <40Gy

Kidneys
V20Gy <25% for contralatearl kidney & <40% for ipsilateral kidney
Mean <18Gy

Liver - V30Gy < 60%
Spleen - mean dose <10Gy

23
Q

What is the treatment given to a HER2+ metastatic oesophageal adenocarcinoma

A

Trastuzumab with cis-cape / carbo-cape / cap-ox

24
Q

What palliative RT can be given to oesophageal cancer
What volume

A

20 in 5 or 30 in 10, for dysphagia or bleeding
CTV - GTV +3cm sup/inf
PTV - CTV +1.5cm all around, and 7mm for field edge if field based RT
6MV POP

25
Q

What is the prognosis for radically treated oesophageal cancer

A

Radical surgery
T1/2 N0 - 50%
T3/4 or N1-3 - 20%

Radical RT - 20%

CRT - 30%

26
Q
A

FRCR2 (28 decks)

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