Upper GI Cancer

27/05/2013 by admin | Oncology

Oesophageal carcinoma:

  1. Incidence increasing – UK 5-10/100,000
  2. Declining squamous cell carcinomas (due to reduced smoking), but increasing adenocarcinoma of distal oesophagus/gastric cardia (linked to Barretts)?
  3. Pathophysiology: – 2 types of oesophageal cancer
    1. o Squamous carcinoma: affects middle third of oes. Associated to cigarette smoking.
    2. o Adenocarcinoma: affects lower third, and merges pathologically with carcinoma of gastric cardia. Theories link this type of cancer to chronic GORD of acid and bile.
  4. P/c: rapidly progressive dysphagia (initially of solids then progress to dysphagia of soft foods and liquids), weight loss.
  5. Ix:
    1. o Barium swallow: first line
    2. o Endoscopy: will often provide histological diagnosis and allow for effective symptom relief (=oesophageal dilatation)
    3. o CT: if suitable for surgery (there is often a high prevalence of cormorbidities) – CT chest and abdo will exclude gross pulmonary and/or hepatic mets and may identify local invasion into pericardium or aorta
    4. o Endoscopic USS: more sensitive for detecting local mets
    5. o Staging laparoscopy: malignant spread to LNs can be missed on CT
  6. Mx:
    1. o Prognosis is poor – 5 year survival = 5%
    2. o Surgery: best chance for cure. But even then, with ‘curative resection, 5 year survival is only 20%
    3. o RT/CT: squamous carcinoma is sensitive to RT. Newer combination regimens are proving effective in adenocarcinoma
    4. o Palliative procedures: to make life more comfortable
    5. o Dilatation: of oes will relieve dysphagia although may have to be repeated
    6. o Laser or argon beam ablation: to ablate exophytic tumours
    7. o Stenting: in tumours causing mediastinal encasement, stenting with self-expanding metal stents provides good relief. 
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