SESAP Questions
===============


**C****ategory** **2, I****tems** **17** **and** **18**

A 66-year-old otherwise healthy man undergoes esophagogastroduodenoscopy for progressive dysphagia. He has no other complaints. Endoscopy reveals a fungating partially obstructing lesion 30 cm beyond the incisors. Microscopic examination of a biopsy from the mass reveals adenocarcinoma, and an additional biopsy 4 cm proximal to the gastroesophageal junction shows Barrett’s esophagitis without dysplasia. The esophagogram and computed tomogram (CT) shown are obtained.

![Figure1](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/42/6/472/F1.medium.gif)

[Figure1](http://canjsurg.ca/content/42/6/472/F1)

![Figure2](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/42/6/472/F2.medium.gif)

[Figure2](http://canjsurg.ca/content/42/6/472/F2)

**Item 17.** Development of the malignancy is most likely related to

1.  smoking

2.  lye exposure

3.  gastroesophageal reflux disease

4.  heredity

5.  esophageal diverticula

**Item 18.** Evaluation shows no sign of metastatic disease and the patient completes a preoperative program of two cycles of cisplatinum and fluorouracil (5-FU) with 45 Gy of radiation therapy.

After complete resection, the patient’s five-year survival would be

1.  5%

2.  10%

3.  35%

4.  50%

5.  75%

For each of the incomplete statements above, select the one answer that is best of the 5 given.

For the critique of this item see page 474.

## Footnotes

*   (Reproduced by permission from *SESAP No 10 1999–2001 Syllabus* Volume 1. For enrolment in the Surgical Education and Self-Assessment Program, please apply to the American College of Surgeons, 633 North St. Clair St., Chicago IL 60611, USA.)