GI Flashcards
What type is oesophageal cancer?
It is an adenocarcinoma if it affects the lower 1/3 of the oesophagus and the squamous cell carcinoma if it affects the upper 2/3
What are the risk factors for oesophagus cancer?
CHRONIC GORD Excessive Smoking or alcohol Age Obesity Baretts oesophagus Chronic achalasia (weakness of oesophageal sphincter) Plummer vinson syndrome Being male Diet high in fats or nitroamines
What is baretts oesophagus?
This is metaplasia of the cells of the lower 1/3 of the oesophagus from squamous cells to simple columnar cells.
How should people with barretts oesophagus be treated?
As they are at high risk of developing of oesophageal cancer…
They should have surveillance- endoscope with biopsies every 2-3 years
And PPI
What is chronic achalasia?
Dysfunction of the lower oesophageal sphincter which means it can’t relax, this causes a functional stenosis/ narrowing and leads to dysphagia of both liquids and solids, as well as heartburn and regurgitation of food.
What is plummer vinson syndrome?
Triad of dysphagia due to the formwtion of oesophageal webs, glossitis and iron deficiency anaemia.
What are the symptoms of oesophageal cancer?
Progressive dysphagia Upper abdo pain Dyspepsia Anorexia Weight loss Hoarseness of voice Cough Nausea and vomiting Odynophagia Reflux
What is the 2WW criteria in terms of Oesophageal cancer?
OGD within 2/52 if the patient has dysphagia
Or
If the patient is > or equal to 55 and has upper abdominal pain/reflux or dyspepsia
What investigations are done for oesophageal cancer?
OGD
If oesophageal cancer is confirmed on the OGD, then a staging CT CAP will be performed
If there is no mets then an endoscopic USS can be performed for local staging
If there are mets then a staging laparoscopy can be performed
If there are palpable lymph nodes then fine needle aspiration should be carried out
If there is haemoptysis/hoarseness of voice then a bronchoscopy should be performed to look for local invasion
What is the management of oesophageal cancer?
It is often found when it is advanced therefore palliative treatments like stenting and nutritional inputs (PEG/ RIG tubes), photodynamic and analgesia.
The curative treatment is surgery, which may be performed alongside radiotherapy or chemoradiotherapy
Surgery=
an oesophagectomy – your surgeon removes the part of the oesophagus containing the cancer
a total oesophagectomy - your surgeon removes your whole oesophagus
an oesophago-gastrectomy – your surgeon removes the top of your stomach and the part of the oesophagus containing cancer
What is the surgery to remove part of the oesophagus and stomach in oesophageal cancer, associated with?
It is associated with an anastomotic leak.
What are the other causes of dysphagia?
Mechanical obstruction- stomach cancer, strictures, enlarged lymph nodes
Neuromuscular causes- achalasia
What are the risk factors for gastric cancer?
FHx Age Male Diet- excess salts, spicy food, excess alcohol, nitrates Gastric adenomatous polyps H pylori infection Pernicious anaemia Group A blood
What are the symptoms of gastric cancer?
Early satiety
Dysphagia
Dyspepsia
B symptoms
Reflux
Epigastric pain
N and V
What may you find on examination of a patient with gastric cancer?
Epigastric mass Palpable virchows node (left supraclavicular lymph node) Hepatomegaly Ascites Jaundice Acanthosis nigricans
Gastric cancers typically spread to the liver, which is why signs of liver failure may be present oxamination.
How do you diagnose gastric cancer?
OGD and biopsy
The tissue from the biopsy is sent for:
- CLO testing (check for H pylori)
- histology
- receptor testing (ie: HER2 which checks whether or not MAB can be used)
What investigations are done after GI cancer is diagnoses?
CT CAP
Staging laparoscopy
+/- PET CT
How do you treat gastric cancer
Most patients are treated with palliative care
- targeted therapy and chemotherapy
- all patients must also be offered nutritional support and a MUST score should be calculated
- a dietitian review should take place and a PEG tube should be enough to ensure adequate nutrition
Curative treatment is with surgery
Total gastrectomy if the cancer is proximal or partial gastrectomy if the cancer is distal
+ lymphadenectomy and chemo pre and post op
What are the complications of gastrectomy?
Dumping syndrome B12 deficiency Iron deficiency Malnutrition Death Anastomotic leak Re operation
What is dumping syndrome?
Where food contents move too quickly into the small intestine resulting in fluid shift and nausea, vomiting, palpitations, sweating p, bloating, cramping, diarrhoea, dizziness, fatigue soon after eating a meal.
Late dumping syndrome= this occurs 2-3 hours after eating a meal, this is where there is a surge of insulin after eating foods high in glucose, resulting in hypoglycaemia.
