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Q1: Presentation (2 min)
"How does oesophageal cancer present?"
- Progressive dysphagia: solids first, then liquids (mechanical obstruction)
- Weight loss (mean 10 kg at presentation)
- Odynophagia, regurgitation, aspiration
- Hoarse voice (recurrent laryngeal nerve)
- Horner's syndrome (sympathetic chain)
- Progressively worsening alarm symptoms in a patient over 50
Q2: Staging (3 min)
"How do you stage oesophageal cancer?"
- OGD + biopsy: diagnosis and histology
- EUS: T (depth) and N (nodes)
- CT/PET-CT: M (distant metastases)
- Laparoscopy: GOJ tumours (peritoneal seeding)
- Bronchoscopy: upper/mid tumours (tracheobronchial invasion)
- CPET: fitness for surgery
Q3: Treatment (3 min)
"What is the standard treatment for resectable oesophageal cancer?"
- CROSS protocol: neoadjuvant CRT (carboplatin + paclitaxel + 41.4 Gy)
- Surgery: Ivor Lewis oesophagectomy 4-6 weeks post-CRT
- 5-year survival: 47% (vs 34% surgery alone)
- Definitive CRT for SCC unfit for surgery
- Palliative: SEMS for dysphagia, chemo for metastatic
Q4: Complications (2 min)
"What are the complications of oesophagectomy?"
- Anastomotic leak (5-15%): fever, sepsis, pleural effusion — NPO, IV antibiotics, drain
- Chylothorax: milky pleural fluid — chest drain, MCT diet, octreotide
- Recurrent laryngeal nerve palsy: hoarseness
- Gastric stasis: pyloroplasty at surgery helps
- Respiratory: atelectasis, pneumonia, ARDS