HPN 2022 March

Page 70


GI FOCUS: OESOPHAGEAL CANCER Distance from incisors

Oesophageal Cancer Interview with Theresa Lowry Lehnen (GPN, RNP, PhD) Clinical Nurse Specialist and Associate Lecturer Institute of Technology Carlow

Cervical esophagus

UES Trachea

when the tumour has reached a relatively locally advanced or even metastatic stage.” Symptoms of oesophageal cancer include:

Oesophageal cancer (OC) is the eighth most common cancer and sixth most common cause of cancer mortality worldwide. Oesophageal cancer is more common in people aged over 60. It affects more men than women. More than 500 people are diagnosed with it in Ireland every year. The oesophagus is the neuromuscular tube that connects the pharynx with the stomach and lies in the posterior mediastinum within the thorax near the lung pleura, peritoneum, pericardium, and diaphragm. The upper and lower oesophagus are controlled by the sphincter function of the cricopharyngeus muscle and gastro-oesophageal sphincter, respectively. The functions of the oesophagus and its sphincters are to transport swallowed materials from the pharynx to the stomach, and to defend the airways and itself from the reflux of gastric contents. Speaking about how oesophageal cancer develops, Theresa Lowry Lehnen, Clinical Nurse Specialist and Associate Lecturer Institute of Technology Carlow says, “Oesophageal cancer occurs when cells in the oesophagus develop mutations in their DNA and the cells grow and divide out of control. The accumulating abnormal cells form a tumour in the oesophagus that can grow to invade nearby structures and spread to other parts of the body. The tumour does not cause symptoms at first, but as it grows causes difficulty with swallowing. As oesophageal cancer expands, the lumen of the oesophagus narrows, and dysphagia occurs due to mechanical obstruction. Due to the muscular and expansive nature of the oesophagus, symptoms from an obstructing or stricturing lesion may only become apparent

Dysphagia Acid reflux pain in the sternum, back or throat Weight loss Anorexia Cough Risk factors for developing oesophageal cancer include increasing age, gender (OC is two to three times more common in males than females), gastroesophageal reflux disease (GORD), Barrett's oesophagus, achalasia, obesity, smoking, alcohol, drinking very hot liquids, poor diet and undergoing radiation treatment to the chest or upper abdomen. The main risk factors associated with development of oesophageal adenocarcinoma are gastrooesophageal reflux, obesity, high intake of red meat and low intake of fruits and vegetables. Oesophageal squamous cell carcinoma develops from squamous epithelial cells and is typically localised to the upper two-thirds of the oesophagus. Tobacco consumption and alcohol intake are the most notable risk factors, although their relative risk varies by region. Theresa says, “The increase in the incidence of oesophageal adenocarcinoma has paralleled with the rise of obesity in the western world. A variety of observational studies, systemic reviews and meta-analyses have shown and confirmed association between obesity and OAC. The risk of OAC in patients with a BMI of 30 or above is approximately 16 times greater compared to those with a normal BMI.” Furthermore, patients with Barrett’s oesophagus have been shown to have a 30 to 60-fold increase in the incidence of oesophageal adenocarcinoma, although the annual absolute risk of developing OAC is 0.12%. The



Aorta Thoracic esophagus

Right crus of diaphragm LES

Abdominal esophagus

incidence of Barrett’s oesophagus is two to three times higher in men than women, and male sex is an independent risk factor for malignant transformation. “The role of HPV infection in the development of oesophageal cancer has long been suspected,” she adds. “Although HPV has been widely studied, the overall rate of HPV infection in oesophageal squamous cell carcinoma remains controversial and there is a lack of robust evidence for a definitive etiological role.

“The association between HPV and oropharyngeal SCC, and the histologic similarities between the squamous epithelium of the oral mucosa and upper oesophagus could suggest a similar association. HPV16 and HPV18 are the most frequently detected types in HPV-associated cancers. Studies have shown a significant association between HPV16 and OSCC, but not HPV18.” Diagnosis, Staging and Treatment In 2019, new national clinical guidelines, ‘Diagnosis, staging