Podcast
Questions and Answers
What is the average resting lumen size of the esophagus?
What is the average resting lumen size of the esophagus?
Which of the following is TRUE about epidemiology of esophageal cancer?
Which of the following is TRUE about epidemiology of esophageal cancer?
What age group is most commonly affected by esophageal cancer?
What age group is most commonly affected by esophageal cancer?
You are evaluating a patient who recently underwent an Upper endoscopy and was diagnosed with a biopsy-proven esophageal adenocarcinoma arising in the region of the gastroesophageal junction. The endoscopy report notes that the epicenter of the tumor was 2.5 cm caudal to the gastroesophageal junction. Which of the following is the most appropriate classification and management approach for this tumor?
You are evaluating a patient who recently underwent an Upper endoscopy and was diagnosed with a biopsy-proven esophageal adenocarcinoma arising in the region of the gastroesophageal junction. The endoscopy report notes that the epicenter of the tumor was 2.5 cm caudal to the gastroesophageal junction. Which of the following is the most appropriate classification and management approach for this tumor?
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What is the overall 5-year survival rate for esophageal cancer?
What is the overall 5-year survival rate for esophageal cancer?
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Which of the following is TRUE about the anatomy of the esophagus?
Which of the following is TRUE about the anatomy of the esophagus?
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Which of the following risk factors is associated with the highest increase in risk for esophageal adenocarcinoma?
Which of the following risk factors is associated with the highest increase in risk for esophageal adenocarcinoma?
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What is the most common genetic mutation found in esophageal cancer biopsies?
What is the most common genetic mutation found in esophageal cancer biopsies?
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Which of the following is TRUE about HER2 status in esophageal cancer?
Which of the following is TRUE about HER2 status in esophageal cancer?
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Which of the following genetic conditions are associated with an increased risk of esophageal adenocarcinoma?
Which of the following genetic conditions are associated with an increased risk of esophageal adenocarcinoma?
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Which of the following is TRUE about Barrett's esophagus?
Which of the following is TRUE about Barrett's esophagus?
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What is the prevalence of Barrett's esophagus in the US population?
What is the prevalence of Barrett's esophagus in the US population?
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What is the risk of progression to cancer for a patient with high-grade dysplasia?
What is the risk of progression to cancer for a patient with high-grade dysplasia?
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In what population is familial clustering of Barrett’s esophagus most common?
In what population is familial clustering of Barrett’s esophagus most common?
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Which of the following is NOT a risk factor for Barrett's esophagus?
Which of the following is NOT a risk factor for Barrett's esophagus?
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Which of the following diagnostic modalities is nearly 100% sensitive in diagnosing Barrett's esophagus?
Which of the following diagnostic modalities is nearly 100% sensitive in diagnosing Barrett's esophagus?
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A patient with dysphagia is being worked up by the GI physician. The basic blood work shows iron-deficiency anemia. The upper endoscopy demonstrated a 'web-like' appearance of the lower esophagus. The Colonoscopy was unremarkable. Based on these findings, the patient is considered at high risk for...?
A patient with dysphagia is being worked up by the GI physician. The basic blood work shows iron-deficiency anemia. The upper endoscopy demonstrated a 'web-like' appearance of the lower esophagus. The Colonoscopy was unremarkable. Based on these findings, the patient is considered at high risk for...?
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What is the recommended frequency of endoscopic surveillance for Barrett’s Esophagus with no dysplasia?
What is the recommended frequency of endoscopic surveillance for Barrett’s Esophagus with no dysplasia?
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Study Notes
Esophageal Cancer
- Anatomy: Esophagus extends from the Upper Esophageal Sphincter (UES) to the Esophagogastric Junction (GEJ).
- Average resting lumen size: 2cm (AP) x 3cm (laterally).
- UES is approximately 15cm from incisors, and GEJ is approximately 40cm from incisors.
- Esophagus divided into cervical, thoracic (upper, middle, lower), and abdominal sections.
- No serosa.
- Blood supply from segmental end-arteries.
- Lymphatic system abundant in submucosal plane.
- Regional nodal basins: cervical, thoracic, and abdominal.
- Cervical nodes include recurrent laryngeal, jugular, and supraclavicular.
- Thoracic nodes include thoracic duct and subcarinal.
- Abdominal nodes include celiac, left gastric, splenic, common hepatic, lesser curve, retroperitoneal, and diaphragmatic.
Epidemiology of Esophageal Cancer
- Males are affected more than females (3:1 ratio).
- Typically diagnosed between 60-70 years.
- 6th leading cause of cancer death globally.
- Incidence varies geographically with highest rates in Central Asia and Northern China.
- Adenocarcinoma more common in USA, increasing in prevalence.
- Squamous cell carcinoma (SCC) most prevalent globally.
- Overall 5-year survival rate approximately 18%.
Definition of Esophageal Cancer
- Esophageal Cancer: Tumor epicenter within the esophagus, lower extent >2cm from EGJ.
- GE Junction Cancer: Tumor lower extent within 2cm of GEJ, involving any portion of esophagus.
- Gastric Cancer: Tumor epicenter >2cm below GEJ.
- Siewert Classification: Categorizes esophagogastric cancers based on tumor location (I, II, and III) regarding treatment approach.
Risk Factors
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Adenocarcinoma:*
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Barrett's esophagus: Significant risk factor (30-60x).
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Gastroesophageal Reflux Disease (GERD): Increased risk with increased symptom duration.
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Smoking: Double the risk.
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Obesity: Triple the risk.
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Male sex: Triple the risk.
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Radiation therapy history: 5x higher risk.
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Genetic mutations (e.g., TP53, ARID1A, SMAD4): Associated with esophageal adenocarcinoma.
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Squamous Cell Carcinoma (SCC):*
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Smoking: Quadruple the risk.
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Alcohol: Pentaple the risk.
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Smoking and Alcohol: Synergistic effect, significantly increasing risk (44x).
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Male sex: Double the risk.
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Age: Risk increases with age.
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Plummer-Vinson syndrome: Associated with risk.
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Achalasia, Zenker's Diverticula: Elevated risk due to stasis and inflammation.
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Tylosis, HPV 16: Increased risk.
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Genetic mutations (e.g., TP53, CCND1, MDM2): Associated with SCC.
Biomarker Screening
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HER2: Protein linked to potential aggressive cancer behavior with variations in prevalence across cancer types. Screening with IHC/ISH is recommended for diagnosis.
- Poorer prognosis, more aggressive tumor invasion, lymph node spread are associated with HER2 positivity.
- MSI/MMR: Mutation detection is particularly considered for recurrent, locally advanced, or metastatic cases. It's helpful for determining the role of PD-1 inhibitors in treatment.
- PD-L1: Useful in advanced stages, evaluated with IHC, to determine the potential use of PD-1 inhibitors.
Genetic Syndromes
- Tylosis (Howell-Evans syndrome): Rare, autosomal dominant condition with elevated risk of esophageal SCC, requiring screening from 20 years.
- Familial Barrett's Esophagus: Clustering of cases within families, predisposes to esophageal adenocarcinoma. Screening starting at 40 years recommended for high risk groups.
- Bloom's Syndrome and Fanconi Anemia: Rare, inherited conditions increasing risk for various cancers, including esophageal SCC, warranting regular endoscopic screening.
Barrett's Esophagus
- Epidemiology: 5% of US population, 1% globally.
- Risk Factors: Age, obesity, GERD duration, male sex, white race, tobacco, familial history, and hiatal hernias.
- Pathology: Substitution of squamous epithelium with intestinal-type epithelium.
- Natural History: Progression to dysplasia and cancer. Risk of progression depends on grade.
- Presentation: Reflux symptoms, sometimes asymptomatic.
- Diagnosis: Endoscopy, biopsies, potentially WATS3D, other advanced endoscopy options for diagnosis.
- Management: PPI, NSAIDs, aspirin, endoscopic removal/ablation for dysplasia, surveillance.
- Surveillance: Different frequency/biopsy approaches according to Barrett's dysplasia grade.
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Description
This quiz covers the anatomy, blood supply, and epidemiology of esophageal cancer. Learn about the sections of the esophagus, the regional lymphatic system, and demographic data related to cancer incidence and mortality. Test your knowledge on this critical health topic.
