Most (70%) are squamous cell carcinomas —typically affecting the mid-oesophagus . Alcohol, smoking, achalasia, head and neck cancer, causti...
Most (70%) are squamous cell carcinomas—typically affecting the mid-oesophagus. Alcohol, smoking, achalasia, head and neck cancer, caustic ingestion and tylosis are risk factors.
The remaining 30% are mostly adenocarcinomas; typically they are distal and associated with reflux disease (i.e. Barrett disease and scleroderma). Endoscopic US (EUS) is preferred for local staging. Common sites for metastasis are the liver, lungs, bones and adrenal glands.
BARIUM SWALLOW
• Irregular, ‘shouldering’ stricture with nodular elements.
• The varicoid variant may appear as thickened folds.
• Check for secondary achalasia with low tumours (due to malignant infiltration of the myenteric plexus).
CT
• Asymmetric thickening of the oesophageal wall (>5 mm) and with dilated proximal oesophagus.
• Loss of perioesophageal fat plane implies local invasion.
• May be resectable if <90° of the aorta are encircled.
PET/CT
• For staging, the sensitivity and specificity of PET/CT are better than those of CT alone, as oesophageal cancer is very fluorodeoxyglucose (FDG) avid.
• PET/CT is especially useful for nodal assessment and tracking response.
• Useful for distinguishing fibrosis from malignancy post-treatment.
• >15% fall in standardized uptake value (SUV) is required for a partial response.
INTERVENTION
• Stenting is an option for symptom control (below C7).
• Stents are typically made of nitinol (nickel/titanium alloy) and covered.
• Complications are bleeding, perforation, migration and tumour in-growth.
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