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Oesophageal Cancer

Surgery > General surgery

Background Knowledge 🧠

Definition

Oesophageal cancer is a malignant tumour arising from the oesophagus, the tube that transports food from the mouth to the stomach.

Types

  • Squamous cell carcinoma (common in the upper/middle oesophagus).
  • Adenocarcinoma (common in the lower oesophagus).

Risk Factors

  • Tobacco and alcohol use.

  • Gastroesophageal reflux disease (GORD).

  • Barrett’s oesophagus (pre-malignant condition).

  • Achalasia.

  • Diet low in fruits and vegetables.

  • History of head and neck cancers.

Clinical Features 🌡️

Symptoms

  • Progressive dysphagia (initially to solids then to liquids).

  • Unintentional weight loss.

  • Epigastric or retrosternal pain.

  • Regurgitation of food.

  • Hoarseness (due to recurrent laryngeal nerve involvement).

  • Respiratory symptoms (e.g., cough) if there’s a tracheoesophageal fistula.

Investigations 🧪

Investigations

  • Endoscopy with biopsy: Primary diagnostic tool.

  • Barium swallow: Might show an ‘apple core’ lesion or stricture.

  • CT and PET scans: For staging and to detect metastasis.

  • Endoscopic ultrasound (EUS): To evaluate depth of tumour invasion and involvement of regional lymph nodes.

Management 🥼

Management

  • Early stage:
    • Endoscopic resection.
    • Radiotherapy and/or chemotherapy.
  • Advanced disease:
    • Surgical resection (oesophagectomy) combined with neoadjuvant therapy.
    • Palliative care (stenting, radiation, chemotherapy) for symptom relief in unresectable tumours.

Prognosis

  • Depends on the stage at diagnosis and overall health of the patient.

  • Generally, the 5-year survival rate is low, especially if diagnosed at advanced stages.

Complications

  • Metastasis to regional lymph nodes or distant organs.

  • Tracheoesophageal fistula formation.

  • Bleeding and anaemia.

  • Stricture or obstruction of the oesophagus.

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Which of the following is not a risk factor for oesophageal cancer?

For squamous cell carcinoma

For adenocarcinoma.

For squamous cell carcinoma.

For squamous cell carcinoma.


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