Cancer of the Oesophagus and Stomach Flashcards
Where does oesophageal cancer occur most commonly?
Cancer with a lot of variability in incidence between countries
20% occur in the upper part
50% in the middle
30% in the lower part
What histological type is oeosphageal cancer?
Squamous proximally used to be the most common but Adenocarcinoma distally has recently become more common
What are the risk factors for oesophageal cancer?
Diet (squamous cell and diets rich in Nitrosamines) Male sex Alcohol Smoking Achalasia Reflux oesophagitis and Barrett’s oesophagus (adenocarcinoma) Obesity Hot drinks Plumber Vinson syndrome
What is barrett’s oesophagus?
Metaplasia of the lower oesophageal mucosa with the usual squamous being replaced by columnar epithelium. Giving a 50-100-fold increase risk of Adenocarcinoma. Barrett’s is associated with GORD, is more common in males, smokers and those who are obese.
How is barrett’s oesopagus managed?
Treatment with PPI and endoscopic surveillance every 3-5years.
What are the clinical features of oesophageal cancer?
Dysphagia and odynophagia (pain when swallowing) Weight loss and anorexia Vomiting Retrosternal chest pain Malaena Hoarseness Cough (paroxysmal if aspiration pneumonia) Hiccups
How should suspected oesophageal cancer be investigated?
Upper GI endoscopy with biopsy
Endoscopic US best for assessing local invasion
CT chest, abdo and pelvis for staging
Endoscopic ultrasound if no metastatic disease
What is the staging for oesopageal cancer?
T1 Invading Lamina propria/submucosa
T2 invading muscularis mucosa
T3 Invading Adventitia
T4 Invasions of Adjacent structures
What is the management for oesophageal cancer?
Survival rates are poor with or without treatment
Neo-adjuvant chemotherapy
T1/T2 radical oesophagectomy (Ivor-Lewis type)
Otherwise Chemoradiotherapy
Aim in Palliative care is to restore swallowing with stents and chemoradiotherapy
What histological type is gastric cancer?
Incidence of gastric cancer is increasing, especially in the west in terms of gastro oesophageal adenocarcinoma.
However, adenocarcinoma of the distal body of the stomach has decreased sharply.
What are the risk factors for gastric cancers?
Peak age 70-80 More common in Japan, China, Finland and Columbia Male sex Pernicious anaemia H-pylori infection Blood group A Atrophic gastritis Adenomatous polyps Lower social class Smoking Diet (high nitrate, high salt, pickling and vitamin C) and nitrosamine
What are the clinical features of gastric cancer?
Dyspepsia (indigestion) Weight loss Abdominal pain Vomiting Dysphagia Anaemia Lymphadenopathy Haemoptysis
What clinical signs would suggest a gastric cancer is incurable?
Signs of incurable disease Epigastric mass Hepatomegaly Jaundice Ascites Raised Virchow’s node
What investigation should be done in someone suspected of having gastric cancer?
Gastroscopy and biopsy
Endoscopic US to evaluate depth of disease
CT chest, abdo, pelvis for staging
Staging laparoscopy for advanced disease
Cytology of peritoneal wash can help identify peritoneal metastases
How is gastric cancer managed?
Early gastric cancers can be resected endoscopically
Partial gastrectomy for advanced distal tumours with lymphadenectomy
Total gastrectomy if tumour < 5cm from OG junction with lymphadenectomy
Neo-adjuvant combination chemo
Chemotherapy for palliation if pain, obstruction of haemorrhage
