Causes of Dysphagia
CA Oesophagus
from Bailey 27th
Survival is poor
- Present with Dysphagia (food sticking in chest after swallowing, in bulbar and cns disorders unable to swallow)
- Regurgitation
- Vomiting
- LOW
Features of Advanced malignancy
Think of up, down, ant and posterior.
- Haemetemesis, melaena
- Recurrent laryngeal nerve palsy (hoarseness)
- Interscapular pain
- Diaphragm pralysis
- L supraclavicular lymphadenopathy (Virchow’s node ; is a bad prognostic factor)
Upper 2/3 : Squamous cell CA (smoking, alcohol are risk factors)
Lower 1/3 : AdenoCA (GORD, Obesity)
Staging is necessary for curative treatment.
Ix
- Endoscopy (only mucosal surface can be examined)
- CT chest and abdomen to stage the disease.
- TNM staging
Management
- Chemoradiotherapy for squamous cell CA
- Radical oesophagectomy
- or palliation : stenting
6 Drains after oesophagectomy
- NG Tube
- CV line
- L IC tube
- R IC tube
- Abdominal drain
- Feeding jejunostomy
- Catheter
- Cannula