MRCS Knowledge: Oesophageal Carcinoma

13/09/14 18:13 Filed in: MRCS Knowledge

MRCS Part B Knowledge: Oesophageal Carcinoma


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Today’s MRCS Knowledge short notes are on oesophageal carcinoma.


Background

Squamous cell carcinoma: upper 2/3 oesophagus
Adenocarcinoma: lower 1/3 oesophagus (Barrett’s oesophagus associated)

Aetiology

  • Achalasia
  • Barrett’s oesophagus: pre-malignant condition secondary to chronic GORD causing squamous to columnar metaplasia in lower oesophagus. Serial OGDs assess progression of dysplasia
  • Diet high in nitrosamines
  • Excess alcohol
  • Smoking
  • Ingestion caustic substances
  • Plummer-Vinson syndrome
  • Howell-Evans syndrome: autosomal dominant condition causing hyperkeratosis of palms and oesophageal malignancy

Signs and Symptoms

  • Worsening dysphagia
  • Solids then liquids
  • Cough
  • Shortness of Breath
  • Haematemesis
  • Odynophagia

Investigations

OGD: visualisation and biopsy for classification and grade
CT Chest, abdo, pelvis: staging by TNM

Management

Surgery: curative oesophagectomy + chemotherapy
Palliative: stent, radiotherapy, chemotherapy

Prognosis

Only 1/3 appropriate for surgery at presentation
Local spread: recurrent laryngeal nerve palsy, Horner’s syndrome, SVC obstruction
5-year survival: 5%

Further Info:
For further info and commonly asked questions on oesophageal carcinoma be sure to sign up to the Question Bank.

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