What are some examples of conditions that often require upper GI surgery?
How does the incidence of oesophageal cancer compare between men and women?
3x higher in men
How many people with oesophageal cancer survive 10 years?
Why is the prognosis of oesophageal cancer so poor?
Symptoms present late
What are common traits of people who end up getting oesophageal cancer?
Eat little fruit and veg
What are the 2 kinds of oesophageal cancers?
Squamous cell carcinoma
Where in the oesophagus does adenocarcinoma occur?
What are risk factors for adenocarcinoma of the oesophagus?
Gastro-oesophageal reflux (such as Barrett's metaplasia)
Where in the oesophagus does squamous cell carcinoma occur?
Proximal and middle third
What are risk factors for squamous cell carcinoma of the oesophagus?
Low socio-economic status
What are some symptoms of oesophageal cancer?
Frequent and persistent hiccups
Acid indigestion, heartburn and reflux
Difficulty when swallowing (dysphagia)
Constant burping, belching and coughing
Pain between the shoulder blades
What are very important symptoms for oesophageal acid?
Dysphagia and weight loss
What investigations are done for oesophageal cancer?
Endoscopy or contrast swallow
Why is endoscopy prefered to contrast swallow for investigating oesophageal cancer?
Can see if is benign or malignant by doing biopsy with endoscopy
What must be done once the diagnosis of oesophageal cancer is confirmed?
Stage the tumour
What staging is used for oesophageal cancer?
Explain the algorithm for staging oesophageal cancer?
1) CT scan of chest and abdomen
2) If metastatic/unfit then no further staging is required and palliative/supportive therapy is given
3) If resectable/fit an EUS is done for T/N staging and a PET CT for M staging
For staging, what is done after the CT of the chest/abdomen if the patient is fit?
EUS for T/N staging
PET CT for M staging
Why is a PET scan done for M staging?
Metastasis in small number of patients is not picked up by CT scan
How is a tumour seen on a CT scan?
Oesophagus should be black due to being full of air, tumour is a different colour
What does the T score of a tumour tell us?
How much the tumour has progressed through the mucosa into the muscle wall then otno the surface and perhaps surrounding structures such as lung or pericardium
What does the N score of a tumour tell us?
If the cancer has entered the lymph nodes
Do node positive or node negative tumours have a worse prognosis?
What does M staging of a tumour tell us?
If metastasis are present
What are common metastasis from oesophageal cancer?
Lungs or liver
What are treatment options for oesophageal cancer for people who are metastatic/unfit?
Stenting (allows them to eat)
Palliative radiotherapy (increases length of life)
Palliative chemotherapy (increases length of life)
What needs to be considered when giving chemotherapy?
Side effects, sacrificing quality of life for more time
What are treatment options for oesophageal cancer for people who are resectable/fit?
Oesophagectomy and chemotherapy
Chemotherapy and radiology if concerns about fitness
What is the 5 year survival rate of someone who recieves an oesophagectomy and chemotherapy for oesophageal cancer?
What is the 5 year survival rate for someone who recieves chemotherapy and radiotherapy for oesophageal cancer?