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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

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

  1. T1/T2: radical curative oesophagectomy + neoadjuvant chemo (cisplatin and 5FU). Surgery has 5-20% mortality, complicated by anastomotic leaks/strictures, reflux.
  2. Local extension: palliative radiotherapy. SE: perforation, haemorrhage, pneumonitis.
  3. 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
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