Related Subjects:
|Assessing Chest Pain
|Achalasia
|Oesophageal Carcinoma
|Diffuse Oesophageal spasm
|Diffuse Oesophageal Perforation - Rupture
|Gastro-Oesophageal Reflux
|Barrett's oesophagus
🧪 Oesophageal Carcinoma has two major types:
– Squamous Cell Carcinoma (SCC) → upper/mid oesophagus.
– Adenocarcinoma → lower oesophagus, strongly linked to Barrett’s.
⚠️ Prognosis remains poor: ~10% 5-year survival. UK incidence ~7–8,000/year.
📖 About
- SCC & Adenocarcinoma are distinct in aetiology, risk factors & location.
- Other rare tumours: lymphoma, melanoma.
- Often diagnosed late → poor prognosis.
🧬 Aetiology
- Squamous Cell Carcinoma (SCC): Upper 2/3 oesophagus.
- Adenocarcinoma: Lower 1/3 oesophagus, usually from Barrett’s metaplasia.
⚠️ Risk Factors
- SCC: 🚬 smoking, 🍺 alcohol, achalasia, coeliac disease, tylosis (AD keratoderma), strictures, thoracic radiotherapy, Plummer–Vinson syndrome, low selenium. Geographical ↑ risk in Iran, China, South Africa. Certain diets (pickled veg, salted fish).
- Adenocarcinoma: Smoking, GORD, obesity, Barrett’s oesophagus (40-fold ↑ risk). Progression: intestinal metaplasia → dysplasia → carcinoma.
🩺 Clinical Presentation
- Often silent until late disease.
- 🔑 Progressive dysphagia (solids → fluids) ± odynophagia.
- Weight loss, anorexia, anaemia.
- Hoarseness (recurrent laryngeal nerve palsy), aspiration pneumonia, chest pain.
- Hypercalcaemia (PTHrP secretion in SCC).
- Metastatic features: supraclavicular nodes (Virchow’s), hepatomegaly, lung mets.
📍 Local Spread
- Direct invasion: trachea, lung, pleura, recurrent laryngeal nerve.
- Lymphatic: paraoesophageal, supraclavicular, coeliac nodes.
- Bloodborne: liver, lung.
🔎 Investigations
- 📉 Bloods: FBC (anaemia), U&E/LFTs, calcium.
- 📷 Imaging: CXR/CT chest-abdo for staging & mets.
- OGD with biopsy = gold standard.
- Endoscopic ultrasound → assess depth & nodes.
- Laparoscopy → staging for lower oesophageal/cardia tumours.
- Bronchoscopy if suspected airway involvement.
- Barium swallow → outlines tumour, but needs biopsy confirmation.
- PET-CT for full staging in operable candidates.
⚕️ Management
- Early (mucosal) lesions: Endoscopic mucosal resection (EMR) or submucosal dissection.
- Attempted curative (localised disease, fit for surgery):
- Surgical resection (30% eligible).
– Lower oesophageal/cardia → Ivor Lewis oesophagectomy.
– Upper/mid → total oesophagectomy.
- Neoadjuvant chemotherapy (cisplatin + 5-FU) esp. in SCC.
- Palliative (majority):
- Relieve dysphagia: stenting, dilatation, laser, radiotherapy.
- Chemo ± radiotherapy for symptom control.
- Nutrition support (PEG/jejunostomy if needed).
- Palliative care involvement early → symptom relief, dignity, family support.
💡 Teaching Pearls:
– Progressive dysphagia + weight loss = cancer until proven otherwise.
– Barrett’s = premalignant → surveillance endoscopy.
– SCC vs Adenocarcinoma: location, risk factors, and demographics differ.
– Always stage thoroughly (OGD + EUS + CT ± PET) before surgery.
