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MET3A > Barrett’s and Oesophageal cancer > Flashcards

Barrett’s and Oesophageal cancer Flashcards

1
Q

What is barrettes oesophagus?

A

When the normal distal oesophageal squamous epithelial is replaced with metaplastic columnar epithelium

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2
Q

What is the cause of barrettes oesophagus?

A

Consequence of persistent oesophageal injury due GORD

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3
Q

What type of cancer does GORD and barrettes oesophagus predispose cause?

A

oesophageal adenocarcinoma

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4
Q

Where is the transition zone in the oesophagus?

A

Lower oesophagus

squamocolumnar junction - Z line lies within 1cm of the
around the lower oesophageal sphincter

lower oesophageal
squamous epithelium meets gastric columnar epithelium

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5
Q

What are the signs and symptoms of GORD?

A

Heartburn

Regurgitation

Chest discomfort

Dyspepsia

Nausea and/or vomiting

Dysphagia (suggestive of stricture or malignancy in context of BO and reflux)

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6
Q

Does everyone with barrettes oesophagus have a history of troublesome reflux?

A

No- Approximately 40% of patents with BO will have no history of troublesome reflux.

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7
Q

How is barrettes oesophagus diagnosed?

A

upper gastrointestinal endoscopy by direct visualisation of the lower oesophagus.

Biopsy should be taken ≥1cm above the GOJ to avoid the natural Z line

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8
Q

What are the 3 main aspects of barrettes oesophagus treatment?

A

Protein pump inhibitors
Surveillance
Endoscopic therapy

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9
Q

What is the mode of action of Protein pump inhibitors?

A

Inhibit H+/K+ ATPases in parietal cells

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10
Q

State the 2 main types of barrettes oesophagus?

A

classical >3cm

short segment < 3cm

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11
Q

What are the 2 main types of cancer which can develop from the oesophagus?

A

Squamous cell carcinoma - upper or middle oesophagus

Adenocarcinoma - lower oesophagus - near the gastro-oesophageal junction (GOJ)

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12
Q

At what age foes oesophageal cancer usually develop? What is the male to female ratio?

A

M:F ratio 3-4:1

age > 50 years

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13
Q

What are the risk factors for Squamous cell oesophageal cancer?

A
  • Smoking
  • Alcohol consumption
  • Previous partial gastrectomy
  • Atrophic gastritis
  • Human papillomavirus (HPV): mainly genotypes 16 and 18
  • oesophageal disorders
  • Foods containing N-nitroso compounds
  • Chewing of areca nuts
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14
Q

What are the risk factors for Adenocarcinoma oesophageal cancer?

A

Chronic reflux

Barrett’s oesophagus: 30-fold increase risk of AC

Smoking

Obesity
Zollinger-Ellison syndrome: gastrin-secreting tumour leading to excess hydrochloric acid.

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15
Q

What are the signs and symptoms of oesophageal cancer?

A

Dysphagia: difficulty swallowing (starts gradually with solid food and progresses to more liquid foods)

Constitutional symptoms: fevers, anorexia, lethargy, weight loss

Weight loss: due to tumour-related anorexia and poor nutrition from swallowing difficulties

Bleeding: haematemesis and melaena

Pain: typically retrosternal pain

Aspiration: cough, shortness of breath, fever

Hoarseness: if there is extension to involve the recurrent laryngeal nerve

Signs

Lymphadenopathy: if local tumour spread

Cachexia

Pallor: due to anaemia

Hepatomegaly: if metastatic spread

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16
Q

When is an Urgent (two week wait) referral for gastroscopy for suspected oesophageal cancer required?

A

Dysphagia, OR

> 55 years with weight loss and one of the following:
Upper abdominal pain
Reflux
Dyspepsia

17
Q

When is an NON Urgent referral for gastroscopy for suspected oesophageal pahology required?

A

Haematemesis, OR

> 55 years with treatment resistant dyspepsia, OR

> 55 years with upper abdominal pain and anaemia, OR

Thrombocytosis with one of the following:
Nausea/vomiting
Weight loss
Reflux
Dyspepsia
Upper abdominal pain
Nausea/vomiting with one of the following:
Weight loss
Reflux
Dyspepsia
Upper abdominal pain
18
Q

How is Oesophageal cancer diagnosed?

A

upper GI endoscopy and biopsies of suspected lesions

19
Q

Which blood tests are conducted when investigating oesophageal cancer?

A

Full blood count

Serum iron, transferrin saturation, total iron binding capacity (TIBC)

Urea & electrolytes

Liver function tests

Bone profile

Clotting screen

Renal function

20
Q

Which imaging tests are conducted when investigating oesophageal cancer?

A

CT chest/abdomen/pelvis: - Help with cancer staging

Abdominal ultrasound - used to assess for liver metastasis

PET-CT - offered to patients with potentially resectable disease (i.e. candidates for surgery) to assess for distant disease not detected by conventional CT.

21
Q

Which special tests are conducted when investigating oesophageal cancer?

A

Gastroscopy: principle investigation for diagnosis.

Endoscopic ultrasound (EUS): can be performed at time of endoscopy. Sometimes completed to help more accurately stage oesophageal cancer if it will change management.

Diagnostic laparoscopy: may be used to more accurately stage oesophageal cancer if it will alter management.

22
Q

Which receptor is tested for on biopsy samples of oesophageal cancer that could help with management?

A

Human epidermal growth factor receptor 2 (HER2)

Targeted therapy against the HER2 receptor may be offered to patients with HER2 positive metastatic oesophageal cancer.

23
Q

What is the treatment for Limited and locally advanced tumours (no metastasis)?

A

Surgical resection,

Squamous cell cancer
Neoadjuvant radiotherapy/chemotherapy the surgical resection

Radical radiotherapy/chemotherapy the, 3 month follow up, then salvage resection

Adenocarcinoma

pre-operative chemotherapy
Restaging
Ressection

Radical radiotherapy/chemotherapy
Restaging
resection

Patients with limited disease may be suitable for endoscopic therapy to remove the oesophageal cancer.

Two options include:

Endoscopic mucosal resection (EMR)
Endoscopic submucosal dissection (ESD)

24
Q

Which chemotherapy drugs are used for Squamous cell carcinoma and Adenocarcinoma?

A

cisplatin/5-fluorouracil

25
Q

How locally advanced/ metastatic oesophageal cancer treated?

A

Palliative treatment for those who are not operative candidates or fit enough to have surgery

Radiotherapy: if tumour lies within a radiotherapy field that allows high-doses to be applied.
may be used to resolve dysphagia as alternative to stenting

Chemotherapy: regimens depend on fitness of the patient.

Local tumour treatment: endoscopic stenting, palliative radiotherapy.

Best supportive care: focusing on symptom control only.

26
Q

In patients with HER2 positive cancers, which chemotherapy drug is used?

A

trastuzumab

27
Q

What are the macroscopic features associated with oesophageal cancer?

A

polypoid fungating
ulcerating
annular constricting
diffuse infiltrating

28
Q

What are the 2 main ways oesophageal cancer spreads?

A

direct

via lymphatics

MET3A (14 decks)

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