Gastric and Oesophageal cancer: clinical Flashcards
What are the signs and symptoms of oesophageal cancer?
Dysphagia Odynophagia (painful swallowing) Haematemesis Regurgitation Dysphonia Weight loss Adenopathy Effusion Hepatomegaly Paraneoplastic syndrome: Hypercalcaemia Inappropriate hormone production
What are the signs and symptoms of gastric cancer?
Dyspepsia Emesis Anorexia Dysphagia Early satiety Upper GI haemorrhage Weight loss Abdominal mass Jaundice Paraneoplastic syndromes
What are important findings on examination for a patient with suspected oesophageal cancer?
Weight loss
Lymph nodes
Liver changes
What investigations are done in suspected oesophageal cancer?
Upper GI endoscopy and biopsy Imaging studies : Barium meal CT (MRI) scan of chest and abdomen Bronchoscopy
Fitness studies
What are important findings on examination of a patient with suspected gastric cancer?
Weight loss
Lymph nodes
Abdominal mass
What investigations are done in suspected gastric cancer?
Upper GI endoscopy and biopsy
Imaging studies:
Barium meal
CT (MRI) scan
What are alarm features in a patient’s history?
>55 years of age Dysphagia Evidence of GI blood loss Persistent vomiting Unexplained weight loss Upper abdominal mass Anaemia
What is the curative treatment for oesophageal cancer?
Surgery- this is the only chance of a cure
How many patients are suitable for surgery in oesophageal cancer?
Which stages of tumour render the patient unsuitable for surgery?
About 50% Tumours not suitable for surgery: Stage T4 or M1 tumours Long tumours Tumours with cervical lymph nodes
What is the surgery for oesophageal cancer?
Removal of oesophagus and lymph nodes
What are contraindications to surgery for oesophageal cancer?
Direct invasion of adjacent structures: e.g. Trachea or bronchus Aorta Pericardium Lung Fixed cervical lymph nodes Widespread metastases Poor medical condition
What are other forms of treatment for oesophageal cancer?
Radiotherapy:
radical especially the cervical oesophagus
Palliative
Intubation/stents
Canalisation:
Dilatation, laser, Diathermy, alcohol
PDT
Terminal care
What is surgery used for in gastric cancer?
How is the surgery carried out?
What can be removed as well as the primary cancer?
For improved survival
For palliation of symptoms
The surgery is via an abdominal operation
Involved adjacent organs can be removed
What are contraindications for gastric cancer surgery?
Widely metastatic disease
Malignant ascites
Brief life expectancy
What procedure is used in surgery for proximal and distal lesions in the stomach?
Total gastrectomy for proximal lesions
Partial gastrectomy for distal lesions
