Dr. Stacks, your favorite Pathologist, has three hobbies: gardening, collecting nerf guns, and quizzing students on the histological features of human anatomy. One day while you are working with him he turns to your and asks, from the inside out, what are the histological tissue layers of the esophagus? You answer:

You are just about to see Mr. Soafa Gus, a 64 year old male of elevated body habitus. He has a history of Barrett’s esophagus, and considers himself an exclusive carnivore: “Veggies are for the weak.” Mr. Gus also confesses to smoking a daily pack of cigarettes, and knocking back 12 brews before bed. Predominantly, esophageal cancer can be broken into squamous cell and adenocarcinoma. Of Mr. Gus’s risk factors which is specific to squamous cell carcinoma?

Dr. Knowitall, is one of your local hospitals prominent figures. She has two things she is known for. Being an absolute force to be reckoned with at any trivia game and an astounding knowledge of medical history. One day while you are working with her, she asks you: “What subtype of esophageal cancer was previously rare but in the last two decades has steadily increased and is now amongst the most common?” You answer:

Currently, for the general population there are no effective screening programs for esophageal cancer in any Western organization. However, guidelines suggest that upper endoscopy is indicated in patients presenting with GERD who have concomitant warning symptoms. Notably, if they are found to have Barret’s Esophagus on upper endoscopy they should consider endoscopic surveillance and treatment based on the amount of dysplasia found. What is an appropriate recommendation for low grade dysplasia?

You’re a 4th year medical student on your first day of a Pathology rotation. You are excited to be working with Dr. Stacks as you’ve heard fantastic things and are hoping for a glowing reference. You gently knock on the door to his office and hear “Come in!”. You enter slowly and begin to introduce yourself: “Hello Sir my name is…” WHAP!!, a nerf dart hits you square in the chest. You reel, startled. Then suddenly Dr. Stacks asks: What is the name given to the disease characterised by metaplastic transformation of the esophageal squamous mucosa into glandular epithelium? You managed to stutter out:

Of the following patients, which should you be most concerned about esophageal cancer?

You’re a third year medical student on your Pathology rotation with Dr. Stacks, a Pathologist. Mid way through your day while looking at some slides he suddenly states: “Come with me”. Silently and with some uncertain urgency you follow him down the halls of your hospital. You reach the cancer treatment center where Dr. Stacks knocks on the door of Dr. Ferthaliezer. Dr. Stacks then states, John, my Petunias have been looking rather dreary lately, any thoughts? Dr. Ferthaliezer states, if your student can tell me the appropriate TNM stage of the following patient with Esophageal cancer I’ll let you in on a tip. The tumor characteristics are: Tumor invades the muscularis propria, there are two positive regional lymph nodes, and a single distant metastasis. You answer:

What would be the preferred treatment modality for a patient with T1a, N0, M0 esophageal cancer that has been noted to be “minimal disease”.

You are working as a doctor in a correctional facility. Your next patient is Dr. Stacks. You remember him fondly, and say “Doc! How did you end up in here.” “Ahhh, you were always one of my favorite students” Dr. Stacks said. “But sadly, a stray nerf dart, hit a stray eye, which triggered a stray law suit, and uncovered a wee bit of an embezzlement scheme I was involved in.” “Now for old time sake, how about you tell me which of following is NOT an acute toxicity of radiation therapy for esophageal cancer.” You want to make Dr. Stacks proud, so you answer:

A patient with localized esophageal cancer treated surgically with curative intent would have a ___% 5 year survival rate and a ___% chance of recurrence of their disease in the first 46 months following their surgery.

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