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Oesophageal cancer (Clinical presentation (Regurgitation, Weight loss,…
Oesophageal cancer
Clinical
presentation
Regurgitation
Weight loss
Dysphagia
Progressive, solids
first then liquids
Anorexia
Odonophagia
Hoarseness
Chest pain
Stridor, wheeze
Halitosis
Cough
Risk factors
Alcohol
Diet
Preserved/nitrate-rich food
Low antioxidants
Hot drinks
Smoking
Infection
HPV
H pylori
Medical conditions
Achalasia
GORD
Tylosis
Previous tx
Mediastinal RT
Drugs
Bisphosphonates
Diagnosis
Examination
General: cachexia, pallor, halitosis, hoarseness
Resp: cervical LNs, stridor, aspiration pneumonia
Abdo: cervical LNs, anaemia, hepatomegaly
Investigations
Bedside
Obs, ECG
Bloods
FBC (infection/inflammation), CRP,
U+E, LFTs, bone profile (mets)
Imaging
EUS (initial detection)
Endoscopy (diagnosis, biopsy)
Ba swallow (strictures)
CT thorax (staging)
PET scan (small distant mets)
Laparoscopy/thorascopy (lower tumours, select cases)
History
HPC: swallow symptoms, red flags
PMH: achalasia, mediastinal RT
DH: current meds, allergies
FH: oesophageal/other Ca
SH: smoking, alcohol, hot drinks,
preserved foods
Staging
TNM system
Epidemiology
9th commonest malignancy
M>F
5% cancer deaths
Pathophysiology
SCC or adenocarcinoma
No clear genetic predisposition
Types
Squamous cell
Proximal 2/3
Declining incidence
Adenocarcinoma
Distal 1/3 and GOJ
Commonest, rising incidence
Management
Initial ABCDE
Definitive
Surgical
Stenting
Indication: palliative for extensive disease
MOA: dilation of malignant stricture, relief
of dysphagia etc.
Surgical resection
Indication: localised disease
MOA: endoscopic mucosal resection (superficial tumours)oesophagectomy (invasive tumours; resection of tumour)
+/- adjuvant/neoadjuvant chemo/RT
Complications: anastomotoc leak, death, pneumonia, atelectasis, recurrent laryngeal nerve injury, chylothorax. DVT/PE
Medical
Immune therapy
Indication: HER2+ metastatic cancers of GOJ
E.g. trastuzumab
Chemotherapy
Indication: neoadj before oesophagectomy;
chemo-RT for locally advanced disease;
chemo alone for metastatic disease
E.g. cisplatin, flurouracil
Radiotherapy
Indication: chemo-RT for locally advanced disease
Definition
Malignant neoplasm of
the oesophagus
Prognosis
Poor, as many cases
present as advanced disease