Mouth & Oesophageal Diseases Flashcards
is mouth cancer common in young people?
incidence is inc
what is the typical mouth cancer pt?
> 50 yo male
aetiology of mouth cancer?
smoking (tobacco, shisha, cigars),
alcohol,
diet,
Infection: HPV, candida, syphilis
presentation of mouth cancer?
asymptomatic, lesions, numbness, pain in mouth/neck, voice change, dysphagia
where do mouth lesions occur
soft sites i.e. tongue & floor of mouth
what is the malignant lesions of the mouth?
erythroplakia
how to diagnose mouth cancer?
history of lesion, screen soft tissue sites, contemplate risk factors
what is oesophagitis
inflammation of oesophagus due to reflux
types of oesophagitis
acute or chronic
what are the etiological differences between acute and chronic oseophagitis?
acute= corrosive aetiology (chemical) or infection chronic= reflux
expand on chronic (reflux) oesophagitis aetiology?
defective sphincter, abnormal oesophageal motility, inc intra-abdominal pressure
how to histologically identify reflux oesophagitis
basal zone expansion due to presence of neutrophils, eosinophils & lymphocytes
what are 2 common complications of reflux oesophagitis
ulcers and Barrett’s oesophagus
other than acute & chronic oesophagitis, what’s the 3rd type of oesophagitis?
Allergic oesophagitis
how to diagnose allergic oesophagitis?
pH probe, endo-corrugated oesophagus, inc eosinophilia
tx for allergic oesophagitis
steroids, chromoglycate (mast cell stabiliser), montelukast (leyukotrine receptor antagonist)
what is achalasia
intermittent dysphagia and impaired relaxation of lower oesophageal sphincter
symptoms of achalasia?
intermittent dysphagia, regurgitation (particularly at night), chest pain due to spasms
ix of achalasia?
CXR & barium swallow
what would be seen on a CXR of an achalasia pt?
dilated oesophagus
what would be seen by a barium swallow of an achalasia pt?
bird-beak appearance
tx for achalasia?
palliative, nifedipine (Ca channel blocker), endoscopy
what is Barrett’s oesophagus?
replacement of stratified squamous epithelium by columnar epi with intestinal metaplasia
aetiology of barrett’s O?
persistant GORD, persistant oesophagitis
what is the main risk barrett’s O poses?
inc risk of oesophageal carcinoma
ix for Barrett’s O?
endoscopy & biopsy (exclude cancer)
tx for Barrett’s?
PPIs, endoscopic mucosal resection, radio frequency ablation
what is the benign oesophageal tumour?
squamous papilloma (HPV related)
what are the 2 types of malignant oesophageal tumours?
squamous cell carcinoma and adenocarcinoma
where does squamous cell carcinoma occur?
upper 2/3 of oesophagus
true/false…
squamous cell carcinoma is most common type of oesophageal cancer/
true
aetiology of SCC of oesophagus?
vitA def, smoking, HPV, oesophagitis, genetics
pathogenesis of SCC?
normal > GORD > Severe dysplasia > SCC
symptoms of SCC?
progressive dysphagia, hoarse voice, malignant symptoms e.g. wt loss
signs of SCC?
ulcer/ lump in mouth
ix of SCC?
endoscopy w biopsy*, CT for staging, USS, barium swallow
staging of SCC?
TNM (diameter of tumour, nodal invasion, mets)
what are the 3 mechanisms of invasion?
local invasion, lymphatic spread, haemtogenous spread
tx for SCC?
surgery, palliation
epidemiology of adenocarcinoma?
caucasian males
where does oesophageal adenocarcinoma occur?
lower 1/3 of oesophagus
pathogenesis of adenocarcinoma?
reflux > chronic reflux oesophagitis > barret’s O > dysplasia > adenocarcinoma
main symptom of adenocarcinoma?
dysphagia
tx of adenocarcinoma?
radio, surgery
what are 2 oesophageal conditions not already mentioned?
mallory weis tear, oesophageal varices
