Esophageal Cancer Quiz

From the inside out, state the histological tissue layers of the esophagus.

Mucosa; Sub-Mucosa; Muscularis Propria; Adventitia

You are just about to see Mr. Soafa Gus, a 64 year old male of elevated body habitus. He has a history of Barrett’s esophagus, and considers himself an exclusive carnivore: “Veggies are for the weak.”  Mr. Gus also confesses to smoking a daily pack of cigarettes, and knocking back 12 brews before bed. Predominantly, esophageal cancer can be broken into squamous cell and adenocarcinoma. Of Mr. Gus’s risk factors which is specific to squamous cell carcinoma?

Heavy Alcohol Consumption

What sub-type of esophageal cancer was previously rare, but in the last two decades has steadily increased and is now among the most common?

Adenocarcinoma

Currently, for the general population there are no effective screening programs for esophageal cancer in any Western organization.  However, guidelines suggest that upper endoscopy is indicated in patients presenting with GERD who have concomitant warning symptoms. Notably, if they are found to have Barret’s Esophagus on upper endoscopy they should consider endoscopic surveillance and treatment based on the amount of dysplasia found. What is an appropriate recommendation for low grade dysplasia?

Consider Treatment; if not then Endoscopy q6-12 months

What is the name given to the disease characterized by metaplastic transformation of the esophageal squamous mucosa into glandular epithelium?

Barret’s Esophagus

Concern about esophageal cancer: 68 year old male with unexplained weight loss and progressive dysphagia?

Yes; most common symptoms

Concern about esophageal cancer: 55 year female with cirrhosis; new onset hematemesis and melena?

No; very concerning for potential variceal bleed

Concern about esophageal cancer: 23 year pregnant female; tastes bile in the morning?

No; most likely reflux due to increased abdominal pressure

Concern about esophageal cancer: 48 year male with excruciating retrosternal chest pain and chest wall crepitus?

No; rule out other causes of chest pain; perhaps esophageal rupture

Concern about esophageal cancer: 35 year female of low socioeconomic status with dyspepsia?

No; possible gastritis secondary to h.pylori infection

If your student can tell me the appropriate TNM stage of the following patient with Esophageal cancer I’ll let you in on a tip. The tumor characteristics are: Tumor invades the muscularis propria, there are two positive regional lymph nodes, and a single distant metastasis.

T2, N1, M1

What would be the preferred treatment modality for a patient with T1a, N0, M0 esophageal cancer that has been noted to be “minimal disease”?

Endoscopic Therapy

Which of the following is NOT an acute toxicity of radiation therapy for esophageal cancer: Esophagitis; Dysphagia; Esophageal Stricture; Dermatitis; Esophageal Perforation?

Esophageal Stricture

A patient with localized esophageal cancer treated surgically with curative intent would have a ___% 5 year survival rate and a ___% chance of recurrence of their disease in the first 46 months following their surgery.

47%; 38%