Cancer of the Upper GI Tract Flashcards
What type of cancer occurs in the Upper GI tract?
Squamous cell carconima ( incidence decreasing)
Caused by nitrosamines, lack of Vit A, C, smoking and alcohol
What type of cancer occurs in the Lower GI tract?
Adenocarcinoma (incidence increasing due to obesity and acid reflux, smoking, alcohol)
What type of cellular change occurs in Lower GI tract?
Metaplasia
What 2 layers are in the GI tract?
Longitudinal
Circular
Where is the oesophagus loated?
Posterior mediastinum, 25 cm long
What supplies the oesophagus with nerve and blood?
Aortic branches
Vagus innervation
What is Barretts oesophagus?
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
How does Barretts oesophagus become malignant?
Specialised intestinal metaplasia
Low grade dysplasia
High grad dysplasia
Invasive colenocarcinoma
Who is oesophageal cancer most common in?
M, over 65 yrs
What are the 2 types of oesophageal cancer?
SCC
Adenocarcinoma
Who is gastric cancer most common in?
M, over 65yrs, poor SES, high prevalence in the East
What cell types line the stomach?
Columnar epithelium
What innervated the stomach?
Vagus nerve
What are the causes of gastric cancer?
gastritis anaemia previous gastric surgery diet smoking family history
Name 5 local symptoms of oesophageal and gastric cancer?
Dysphagia Chest pain Dyspepsia Haematemesis Vomiting
Name 5 advanced symptoms of oesohpageal and gastric cancer?
Weight loss Lymph node Ascites Hoarseness Epigastric mass
How do we stage upper GI cancers?
CT scan
Endoscopic ultrasound
Laprascopy
TNM = tumour in wall of organ, malignant lymph nodes, metastatic disease
Name 5 oesophageal cancer treatments?
Oesophagectomy - mortalilty 5-10%
Pre op chemo
Tri modality treatment
Primary chemo and radiotherapy
Name 4 treatments for dysphagia?
Endoscopic stent placement
Tumour destruction
Palliative chemo
Palliative radiotherapy
What are the problems with oesophageal stents?
oesophageal perforation Stent migration Tumour overgrowth blockage Disintegration
How can we treat gastric cancer?
RADICAL :
surgery
gastrectomy
lymphadenopathy
PALLIATIVE:
treat blood loss
remove gastric outlet obstruction
improve dysphagia
