Review the following GP referral for a 70-year old man who has been referred via the 2-week wait pathway.
Thank you for seeing this gentleman who has had progressive dysphagia for the last 8 months. He is struggling with solid foods now, but is able to tolerate liquids. He has moved to a soft diet as a result. He has lost around 3.5kg in weight over the last 2 months (his weight is currently 95kg, giving him a BMI of 32). He does not smoke and drinks around 10 units of alcohol per week.
Arnold, M., Soerjomataram, I., Ferlay, J. and Forman, D., 2015. Global incidence of oesophageal cancer by histological subtype in 2012. Gut, 64(3), pp.381-387.
Harley, M., Yin, L., Amanuel, H., Zeki, S., Burch, J., Kumar, M., Walker, G., Dewar, D. and Hayee, B.H., 2021. PTU-4 Prospective validation of the edinburgh dysphagia score in South-east London.
NICE, 2021, Gastrointestinal tract (upper) cancers – recognition and referral, available at https://cks.nice.org.uk/topics/gastrointestinal-tract-upper-cancers-recognition-referral/ (accessed: 4/11/22)
Rhatigan, E., Tyrmpas, I., Murray, G. and Plevris, J.N., 2010. Scoring system to identify patients at high risk of oesophageal cancer. Journal of British Surgery, 97(12), pp.1831-1837.
Kamran, U., King, D., Banks, M., Barker, S., Caffrey, M., Cheung, D., Evans, J., Fox, M., Glynn, M., Greenaway, J. and Gupta, S., 2021. OTU-12 Validation of Edinburgh dysphagia score in a national evaluation of upper GI cancer 2ww pathway.
Smyth, E.C., Lagergren, J., Fitzgerald, R.C., Lordick, F., Shah, M.A., Lagergren, P. and Cunningham, D., 2017. Oesophageal cancer. Nature reviews Disease primers, 3(1), pp.1-21.
Lagergren, J., Smyth, E., Cunningham, D. and Lagergren, P., 2017. Oesophageal cancer. The Lancet, 390(10110), pp.2383-2396.
0 of 5 Questions completed
You have already completed the test before. Hence you can not start it again.
Test is loading…
You must sign in or sign up to start the test.
You must first complete the following:
0 of 5 Questions answered correctly
Time has elapsed
You have reached 0 of 0 point(s), (0)
Earned Point(s): 0 of 0, (0)
0 Essay(s) Pending (Possible Point(s): 0)
Which of the following is a validated scoring tool for identifying those at higher and lower risk of oesophageal cancer?CorrectIncorrect
To calculate the EDS (Edinburgh Dysphagia Score) for this patient, what further information would you need (select all that apply)?CorrectIncorrect
The patient tells you that he has longstanding GORD, which is partially managed with PPI use, and that the food feels like it gets stuck in the mid-chest.
The EDS can be seen below:
(Image available at https://mft.nhs.uk/app/uploads/sites/4/2021/05/The-Edinburgh-Dysphagia-Score.pdf, accessed on 4/11/22)
With an EDS of 8, this patient does not fall within the lower risk category and requires a gastroscopy on the 2-week wait pathway. According to NICE guidelines, which of the following patients would require a 2-week wait referral for oesophageal cancer:CorrectIncorrect
The patient undergoes gastroscopy, and the following is seen at endoscopy at 32cm from the incisors:
Image available at https://thoracickey.com/ivor-lewis-esophagectomy-2/ (accessed 4/11/22)
What is the most likely diagnosis, based on the image and history?CorrectIncorrect
The patient is referred to the upper GI MDT, following a staging CT chest, abdomen and pelvis, and histology results are reviewed. Histology reveals OAC extending beyond the adventitia with 4 local lymph nodes involve, and the presence of metastatic disease.
What is his TNM category?CorrectIncorrect