-
What is a straight collapsible 10 in tube that functions as a passageway thru the thorax
esophagus
-
The Esophagus begins at the base of the ____ at the level of ___ and descends behind the trachea thru the ____
-
The esophagus penetrates the diaphragm thru an opening, the ___, and is continuous with the stomach on the abdominal side of the diaphragm
Esophageal hiatus
-
Where is the esophagus in close proximity to?
Aorta and Trachea
-
THe cervial esophagus is about ___ ling and extends from the level of ___ to the level of ___
-
Esophagus can be broken up into cervical and thoracic but also into
- Upper 3rd
- middle 3rd
- lower 3rd
-
Where are the esophageal cancers least and most common?
- Least in the upper 3rd
- Most in the middle or lower 3rd
-
Drainage of the esophageal lymphatics is unpredictable and can skip met. A distance of as much as ____ of normal esophagus may be interposed between site of tumor and lymphatic met
8 cm
-
Which nodes are most important in esophageal cancers
-
What % of all cancers are esophageal?
What % of all cancerl deaths are esophageal?
-
Men are how many more times likely to get esophageal CA than women?
3-4 more times
-
African American are ____ higher risk than whites for esophageal CA
50%
-
What is the age of diagnosis for esophageal CA
55-85
-
What are some incidences and etiology of esophageal CA
- alcohol
- tobacco
- Barrett's Esophagus
- Achalasia
- Plummer-vinson
-
The distal part of the esophagus is lined with ____ instead of ____ like the beginning.
- columnar epithelium
- stratified squamous
-
What is a disease of the muscle of the esophagus in which the lower 2/3 loses normal peristaltic activity?
Achalasia
-
What is a disease that is in response to chronic GERD and changes the lining consistency of the esophagus
Barrett's Esophagus
-
What is an iron deficient anemai that causes a difficulty in swallowing
Plummer vinson syndrome
-
what are some clinical presentations of esophageal CA
- #1 dysphagia and weight loss
- chest pain
- regurgitation
- aspiration
- odynophagia
- hematoemesis (vomitting blood)
- coughing
- hemoptysis (spitting up blood)
- hoarseness
-
What are ways to detect esophageal CA
- chest xray
- PET/CT
- esophagoscopy
-
What % of esophageal CA is located in the middle 3rd?
40-50% #1 spot
-
What % of esophageal CA is located in the upper 3rd?
10-25 % least common
-
What % of esophageal CA is located in the lower 3rd
25-50%
-
What is the most common pathology for esophageal CA
Squamous cell (upper and middle)
-
What is the cancer called if found in this distal part or lower 3rd of the esophagus near the GE junction?
Adenocarcinoma
-
What is the staging for esophageal ca
TNM and based on outward extension
-
What is the 5 year survival rate for esophageal ca
5%
-
Once esophageal CA is in the ____ it can skip around via lymphatics
submucosal layer
-
Where are distant esophageal mets found
- #1 LIVER
- lung
- bone
- adrenals
- brain
-
How can esophageal ca spread?
- lymphatics
- local invasion (trachesophageal, bronchoesophageal)
- blood
-
Where can surgery be done for esophageal ca
middle and lower 3rd and only for small non-mets
-
What are the complications for esophageal CA
- anastomic leaks
- PE
- myocardial infarction
- strictures
- GE reflux
-
Which chemo durgs are used for esophageal ca
- 5-FU, cisplatin
- used in conjunction with radiation for better local control and distant met disease
-
what margin do you use to treat esophageal CA with radiation
- 5cm superior and inferior
- 2-3 cm laterally
-
If you have a lesion in your esophagus of the lower 3rd, how would you treat?
Treat with fields to include the mediastinal nodes and celiac axis
-
If you have a lesion in your esophagus of the upper 3rd, how would you treat?
A field that begins at the level of the thyroid cartilage and ends at the level of the carina to include the SCV nodes, low anterior cervial, and mediastinal nodes.
-
If you have a lesion in your esophagus of the middle 3rd, how would you treat?
- treat to include
- perisophageal modes
- mediastinal nodes
-
Which fields are used to treat the bulk of the esophageal tumor?
AP/PA
-
Which boost fields are done to treat esophageal ca
- a 3-field technique- AP and 2 posterior obliques, or
- olbiques, laterals or IMRT
-
How should you position a patient for treatment of esophageal ca
- Supine with arms overhead or by side
- OR
- prone with arms over head
-
When treating esophageal CA using radiation with chemo, what dose do you use?
5040 cGy with off cord at 3600-4500 cGy
-
If using radiation alone to treat esophageal CA, what dose do you use?
6500 cGy with off cord at 3600-4500 cGy
-
What critical structures do you worry about when treating with radiation for esophageal ca
-
What are the side effects for radiating esophageal ca
- #1 ESOPHAGITIS
- ulceration
- decreased blood counts
- radiation pneumonitis
- pericarditis
- strictures
- transvers myelitis
|
|
