Oesphagus Cancer
Reference: OHCM 508, Lec Not Onc 87
Risk Factors
Old, male, white. Diet, alcohol, smoking, achalasia, Plummer-Vinsom,
obesity.
Reflux
disease leads to Barret's oesophagus (metaplasia). Anything predsposing
to reflux will increase the risk of oesophageal cancer: hiatus hernia,
obesity.
Pathology
Squamous:
upper 2/3 of oesophagus
Adenocarcinoma:
lower 1/3 of oesophagus. Growing in frequency.
Can be ulcer, papilliferous mass, or annular constriction
Clinical
Dysphagia, odynophagia, weight loss, haematemesis, chest pain, lymphadenopathy, anorexia
If affects upper 1/3 of throat:
hoarseness, cough.
Investigations
-
Endoscopy and biopsy
-
Barium swallow if unsuccessful: irregular filling defect
-
Staging: CT (liver), endoscopic USS, CXR + bronchoscopy (exclude lung 1
o )
Spread
Local:
mediastinum
Lymph:
para-oesophageal
Blood:
liver, lungs
Staging
TO: carcinoma in situ
T1: lamina propria/submucosa
T2: muscularis propria
T3: adventitia
T4: adjacent
NX: no
nodes can be assessed
N0: no node spread
N1:
regional node mets
M1: distant
Management
-
T1/T2:
radical curative oesophagectomy + neoadjuvant chemo (cisplatin
and 5FU). Surgery has 5-20% mortality, complicated by anastomotic
leaks/strictures, reflux.
-
Local extension:
palliative radiotherapy. SE: perforation,
haemorrhage, pneumonitis.
-
Metasteses:
symptomatic. Stenting, radiotherapy, NGT/PEG (consider these carefully, may be better not to feed).
Hydration and hygiene important. Pain relief.
Prognosis
T0: 95% 5YS
T2-3: 30-40% 5YS
N1: 10-30% 5YS
M1: <2% 5YS
