Esophageal carcinoma and gastric cancer Flashcards
RF esophageal carcinoma
- Etoh
- Tobacco
- GERD→Barretts esophagus (metaplasia)→Adenocarcinoma
- Obesity vitamin deficiency (ie China)
- Familial Hx
Clinical esophageal carcinoma
- Dysphagia*- Progression from solid food to liquids; Rapid
- Weight loss >50%
- Regurgitate food- Epigastric pain/retrosternal pain/bone pain from mets
- Chronic cough
- Hoarseness/dysphonia
- Virschow node- lymph node in left supraclavicular fossa
- Cachectic
Dx esophageal carcinoma
Endoscopy with biopsy
How to stage esophageal carcinoma
EUS CT Broncoscopy PET scan Laproscopic staging
Tx esophageal carcinoma
Surgery- Esophagectomy
- for N2 and greater
Chemo and XRT for everyone else
-5-FU, Cisplatin, Paclitaxel, Anthracyclines
Prevent esophageal carcinoma
STOP GERD
Discontinue alcohol and smoking
MC cause gastric cancer
adenocarcinoma
Areas where gastric cancer MC
Asia and S. America
Cause gastric cancer
- Inherited predisposition
- H. Pylori*- Strongest RF as also associated w/ chronic atrophic gastritis
- Smoking
- Pernicious anemia
- Previous gastric surgery
- Obesity
- Diet- Pickled veggies, salted fish, smoked meats, salt
- Adenomatous polyps
- Radiation exposure
Clinical gastric cancer
- Insidious presentation
- Indigestion
- Nausea/Vomiting
- Dysphagia
- Early satiety/Anorexia
- Weight loss
- Melena/Hematemesis
- Local spread to omenta, pancreas, diaphragm, mesocolon, transverse colon, duodenum
- GOO- gastric outlet obstruction
- SBO
- Palpable enlarged stomach
- Hematogenous spread liver
- Sister Mary Joseph Node- periumbilical lymph node
- Virchow Node- supraclavicular node
- Hepatomegaly
Dx gastric cancer
EGD with bx
What blood levels elevated in gastric cancer
CEA : carcinoembryonic antigen
CA 19-9
Tx gastric cancer
Surgery- mainstay tx
- Total gastrectomy
- Esophagogastrectomy- Tumor @ GEJ and Cardia
- Subtotal gastrectomy- Tumors of distal stomach
Adjuvant chemoradiotherapy
o Post-operatively = std of care in US
o 5-FU and Leucovorin
