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Oesophageal cancer

Definition
  • Oesophageal cancer is a malignant tumour arising from the oesophagus, the tube that transports food from the mouth to the stomach.
Etiology
  • Main types: Squamous cell carcinoma (common in the upper/middle oesophagus) and 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 Presentation
  • 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
  • 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
  • Early stage:
    • Endoscopic resection.
    • Radiation 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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