Oesophageal cancer

Condition 

• Oesophageal cancer

Definition

• Metaplasia of the squamous carcinoma to columnar epithelium 

Main features

• Dysphagia at beginning of meal 
• Dysphagia for solid food steadily progressive over weeks
• Can remain silent and tends to be invasive when diagnosed
• Hiccoughs may be an early sign
• Hoarseness and cough (upper third) 
• Discomfort or pain-throat, retrostenral, inter scapular
• Weight loss can be striking 
• Associations: GORD, tobaccco, Barrett oesophagus --> weak evidence that PPIs help to prevent development of malignancy

Investigations

• Endoscopy
• SCC (most common) and adenocarcinoma
• Adenocarcinoma associated with Barrett oesophagus (0.5% per cent per year, life time risk of less than 5%)

Treatment

• Depends on staging, most likely palliative surgery. 

References

• John Murtagh's General Practice 5th edition