Cancer of the Upper GI Tract

Question 1

What type of cancer occurs in the Upper GI tract?

Answer 1

Squamous cell carconima ( incidence decreasing)

Caused by nitrosamines, lack of Vit A, C, smoking and alcohol

Question 2

What type of cancer occurs in the Lower GI tract?

Answer 2

Adenocarcinoma (incidence increasing due to obesity and acid reflux, smoking, alcohol)

Question 3

What type of cellular change occurs in Lower GI tract?

Answer 3

Metaplasia

Question 4

What 2 layers are in the GI tract?

Answer 4

Longitudinal

Circular

Question 5

Where is the oesophagus loated?

Answer 5

Posterior mediastinum, 25 cm long

Question 6

What supplies the oesophagus with nerve and blood?

Answer 6

Aortic branches

Vagus innervation

Question 7

What is Barretts oesophagus?

Answer 7

Genetic modification of metaplastic response to gastro oesophageal reflux
Defined as:
more than 3cm of columnar lined oesophagus
Specialised intestinal metaplasia
Risk of malignany 0.5%/year

Question 8

How does Barretts oesophagus become malignant?

Answer 8

Specialised intestinal metaplasia
Low grade dysplasia
High grad dysplasia
Invasive colenocarcinoma

Question 9

Who is oesophageal cancer most common in?

Answer 9

M, over 65 yrs

Question 10

What are the 2 types of oesophageal cancer?

Answer 10

SCC

Adenocarcinoma

Question 11

Who is gastric cancer most common in?

Answer 11

M, over 65yrs, poor SES, high prevalence in the East

Question 12

What cell types line the stomach?

Answer 12

Columnar epithelium

Question 13

What innervated the stomach?

Answer 13

Vagus nerve

Question 14

What are the causes of gastric cancer?

Answer 14

gastritis
anaemia
previous gastric surgery
diet
smoking
family history

Question 15

Name 5 local symptoms of oesophageal and gastric cancer?

Answer 15

Dysphagia
Chest pain
Dyspepsia
Haematemesis
Vomiting

Question 16

Name 5 advanced symptoms of oesohpageal and gastric cancer?

Answer 16

Weight loss
Lymph node
Ascites
Hoarseness
Epigastric mass

Question 17

How do we stage upper GI cancers?

Answer 17

CT scan
Endoscopic ultrasound
Laprascopy
TNM = tumour in wall of organ, malignant lymph nodes, metastatic disease

Question 18

Name 5 oesophageal cancer treatments?

Answer 18

Oesophagectomy - mortalilty 5-10%
Pre op chemo
Tri modality treatment
Primary chemo and radiotherapy

Question 19

Name 4 treatments for dysphagia?

Answer 19

Endoscopic stent placement
Tumour destruction
Palliative chemo
Palliative radiotherapy

Question 20

What are the problems with oesophageal stents?

Answer 20

oesophageal perforation
Stent migration
Tumour overgrowth
blockage
Disintegration

Question 21

How can we treat gastric cancer?

Answer 21

RADICAL :
surgery
gastrectomy
lymphadenopathy

PALLIATIVE:
treat blood loss
remove gastric outlet obstruction
improve dysphagia