Oesophageal cancer

1. Oesophageal cancer
Cancer of the oesophagus takes the
form of either squamous cell carcinoma
or adenocarcinoma of the oesophageal
mucosa

2. Etiology and risk factors
• The cause is unknown but it is probably
multifaceted
• The major risk factors include:-
Cigarette smoking
Alcohol consumption
HPV has been found in 70% of clients with SCC
of the oesophagus
The greatest risk in AC is Barrett’s oesophagus

3. Etiology and risk factors cont’d
• Other risk factors for AC include:-
Obesity
Ingestion of smoked meats
Poor nutritional intake of vitamin A, C and
minerals such as magnesium, selenium and
zinc

4. Diagnosis
• There are no procedures for screening to
detect the conditionearly
• Once Barrett’s oesophagus are detected, it is
recommend that endoscopic surveillance
every 1 to 3 years be initiated
• Health promotion and maintenance behaviour
involve:-
Limiting or stopping smoking, alcohol,
ingestion of hot food and beverages

5. Pathophysiology
• The oesophagus is lined with squamous
epithelium which is continuous until it reaches
the gastroesophageal junction
• At the junction, columnar tissue lines the
oesophagus
• Most cancers of the oesophagus begin as
slow-growing tissue changes or dysplasia

6. Squamous Cell Carcinoma
• This is frequently found in the proximal or mid
oesophagus
• Cellular changes are usually seen before the
development
• Changes are found more often in smokers
than non smokers
• SCC can be classified as polypoid, ulcerative,
or infilltrative

7. Squamous Cell Carcinoma cont’d
• Infiltrative tumours of the oesophagus expand
locally and rapidly causing thickening and
narrowing of the lumen
• A polypoid mass projects into the lumen
obstructing the lumen if undetected
• Ulcerative lesions are raised and may expand
into the mucosa elevating until obstructive

8. Adenocarcinoma
• Arise from columnar epithelium of the
oesophagus
• The columnar epithelial changes are usually
attributed to Barrett’s oesophagus
• Because the oesophagus has no serosal layer,
tumours are allowed to spread to adjacent
tissue and lymphatic nodes early.

9. Adenocarcinoma cont’d
• The rich lymphatic supply to the mucosa
provides an excellent means for the cancer to
metastasize widely and quickly causing the
tumour to be unresectable
• Common distant metastatic sites are liver,
lung, pleura and kidneys
• Other areas include bone, peritoneum and
brain

10. Clinical manifestation
• Dysphagia- which is progressive
• Odynophagia
• Pain in the epigastric region or sternal area
• Loss of appetite
• Malaise
• Increase in salivation and mucus in the throat
• Nocturnal aspiration
• Regurgitation
Manifestations are usually not apparent until the cancer
involves the circumference of the oesophagus

11. Diagnosis
• Endoscopy with biopsy and cytology
examination is the only definite method of
diagnosing oesopahgeal cancer
• Ultra sound
• CT scan exploratory laparatomy may be used
to visualise and biopsy possible for metastasis

12. Management
• Inhibit tumour growth
Treatment depends on tumour’s location, size,
metastases, and performance status of the client
If it is found in the early stage, treatment is directed
toward cure; unfortunately, it is directed in late
stages when treatment becomes palliative, aimed
specifically at allowing the client to continue to
live longer with good quality of life

13. Radiation therapy
• This can be used alone as a single therapy or
before surgery (neoadjuvant), after surgery
(adjuvant), or concurrently with 5-fluorouracil (5-
FU) by continuous infusion (chemoradiation)
• It reduces tumour size and slows tumour growth
• Because radiation can cause stenosis of the
oesophagus, treatments are ussually
administered over a 6 to 8 weeks to minimise this
effect

14. Chemotherapy
• This may be single or a combination of agents
• The goal is to relieve manifestations and
reduction of tumour size
• Neoadjuvant chemotherapy can facilitate surgical
resection by reducing tumour size and
invasiveness
• Commonly used drugs include:- cisplatin
(Platinol) and 5-fluorouracil (5-FU) docetaxel
(Taxotere), irinotecan (Camptosar)and oxaliplatin
(Eloxatin)

15. Chemotherapy cont’d
• Newer agents used in conjuction with
chemotherapy are the antiangiogenic
(bevacizumab, {Avastin} and the anti-EGFR
immunoglobulin cetuximab (Erbituxl) in the
treatment of oesophageal cancer

16. Photodynamic therapy
• This is a relatively new therapy for treatment
of oesophageal cancer in clients who are not
candidates for surgery
• The client receives an injection of a light
sensitive drug (Photofrin), which is followed 2
days later with a special fiberoptic probe with
a light-bearing tip placed in the oesophagus
• The light activates the Photofrin and kills only
cancer cells

17. Photodynamic therapy cont’d
• This is an outpatient procedure and uses
conscious sedation, takes about 13 minutes to
perform and enables about 1 inch of tumour
to be removed
• Clients return home the same day and resume
their usual activities the same day

18. Maintain nutrition
• This is a major goal for the client
• Not only does the cancer cause the client to
be at risk for malnutrition, but also the
treatments (both radiation therapy and
chemotherapy) carry a risk of mucositis,
nausea, vomiting and dehydration
• Side effects of must be anticipated and
management swift

19. Maintain nutrition
cont’d
• Early in the disease the client may be able to
tolerate small, frequent feedings of soft or
semisoft goods
• As the disease progresses, a feeding tube may be
needed
• If necessary, feeding gastrostomy or jejunostomy
may be created
• Proper positioning after meals is necessary for
those experiencing frequent regurgaitation
• Keep the head of the bed always elevated at 30
defrees