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Oesophageal Adenocarcinoma — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyOesophageal AdenocarcinomaRACP Adult Medicine

A 65-year-old man presents with progressive dysphagia to solids over 4 months and 10 kg weight loss. Upper GI endoscopy shows a stricturing lesion at the gastro-oesophageal junction. Biopsy confirms adenocarcinoma. CT and PET show no distant metastases. EUS shows invasion into the muscularis propria (T2N0). What is the recommended management?

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Correct answer: C — Neoadjuvant chemoradiation followed by surgical resection

For locally advanced oesophageal adenocarcinoma (≥T2 or node-positive), neoadjuvant chemoradiation followed by surgical resection (CROSS regimen – carboplatin/paclitaxel with concurrent 41.4 Gy radiation) is standard of care based on the CROSS trial, which showed significant survival benefit. For T1 tumours with no nodal involvement, upfront surgery may be appropriate. EMR is only suitable for T1a (mucosal) lesions.

Reference: Cancer Council Australia – 2021 – Optimal Care Pathway for Oesophageal Cancer