Lecture 16- Upper GI cancer

Question 1

Upper GI malignancy symptoms

Answer 1

• Dysphagia
• Epigastric pain
• Jaundice ​

Question 2

Dysphagia

Answer 2

Difficulty swallowing- usually progressive dysphagia

Question 3

types of dysphagia

Answer 3

• Caused by a blocked
  
  • Extraluminal causes
  • Intraluminal causes
  • Luminal causes

Question 4

progressive dysphagia example

Answer 4

when overtime swallowing solids becomes too hard - e.g. can only drink

Question 5

• Red flag (ALARM) alongside dysphagia

Answer 5

• Anaemia
• Loss of weight
• Anorexia
• Recent onset of progressive symptoms
• Masses/ melaena

Question 6

Causes of dysphagia- Benign

Answer 6

• Strictures
• Foreign bodies
• Nerves

Question 7

Causes of dysphagia- malignant

Answer 7

• type of carcinoma links to its epithelium
  
  • Stratified squamous= squamous cell carcinoma
    
    • Columnar epithelium= adneocarcinomas

Question 8

oesophageal cancer are prodominantly

Answer 8

squamous cell carcinomas

(lower 1/3 can develop into adenocarcinoma)

poor prognosisis

Question 9

risk factors for oesophageal cancer

Answer 9

• Barrets
• Smoking
• Spread is common at presentation

Question 10

diagnosis of barretts oesophagus

Answer 10

• Endoscopy
• Barium swallow

Question 11

epigastric pain red flags

Answer 11

• Malena
• Haematemesis
  
  • Gastric cancer
  • Varices
  • Ulcers
  • Mallory Weiss (tear in oesophagus’
• Weight loss
• Risk factors for gastric cancers

Question 12

benign causes of epigastric pain

Answer 12

• Gastritis
• Peptic ulcers
• Pancreatitis etc

Question 13

malignant cause of epigastric pain

Answer 13

gastric cancer (poor prognosis)

Question 14

what type of cancer is gastric cancer

Answer 14

adenocarcinoma

rarer- gastric lymphoma (better prognosis)

gastrointestinal stomal tumas–> sarcomas (usually asymptomatic and incidental finding)

Question 15

risk factors for gastric cancer

Answer 15

• Smoking
• High salt diet
• Family history
• H. pylori
• Increased age
• male

Question 16

gastric cancer diagnosis

Answer 16

endoscopy

Question 17

symptoms of gastric cancer

Answer 17

• Weight loss
• Outflow obstruction
• Malena
• Haematemesis

Question 18

treatment of gastric cancer

Answer 18

• Curative surgery
• Screening (less prevalent here due to less salty diet (in japan much more prevalent- have screening program)

Question 19

red flags alongside jaundice

Answer 19

• Unintentional weight loss
• Hepatomegaly (irregular border)
• Ascites cause by damage by cancer to the liver
  
  • Portal hypertension= increased hydrostatic pressure
  • Liver function decrease = less albumin = less oncotic pressure
• Painlessv

Question 20

malignant causes of jaundice

Answer 20

• Primary Malignancy is very rare
  
  • Hepatocellular carcinoma- links to underlying condition (chronic inflammation)
• Metastasis- common site due to portal circulation
  
  • Breast
  • Colon
  • Lung
  • Skin
  • Ovaries

Question 21

• 3 ways of metastasises

Answer 21

• Haematogenous (through the blood)
• Lymphatic spread (carcinoma)
• Transcoelomic spread (through body cavity e.g. abdominal cavity and peritoneum)

Question 22

• Pancreatic cancer 96% are

Answer 22

(extremely poor prognosis)

• exocrine ductal adenocarcinoma

Question 23

symptoms if head of pancreas involved

Answer 23

jaundiced due to compression on common bile duct- obstruction

Question 24

symptoms if tail body

Answer 24

more vague symptoms – malabsorption

Question 25

• Neuroendocrine cell pancreatic cancer

Answer 25

(rare)- can produce insulin

Question 26

risk factors for pancreatic cancer

Answer 26

• Risk factors
  
  • Family history
  • Smoking
  • Male
  • Increased age
  • Chronic pancreatitis

Question 27

• Rarer malignancy which causes jaundice

Answer 27

• Cholangiocarcinoma (poor prognosis)- bile duct cancer
  
  • Can have metastatic disease at presentation