Oeosphageal and stomach malignany

Question 1

Squamous cell carcinoma risk factors

Answer 1

Alcohol

Smoking (tobacco)

M>F= 3:1

Question 2

Types of oesophageal cancer

Answer 2

Squamous cell carcinoma

Adenocarcinoma

Question 3

Oesophageal Adenocarcinoma risk factors

Answer 3

Obesity

GORD

Barrett’s oesophagus

M>F= 5:1

Question 4

Squamous cell carcinoma treatment

Answer 4

External beam Chemoradiation

Neoadjuvant chemo followed by radical resection

Question 5

Oesophageal Adenocarcinoma treatment
- small
- large
- Palliative

Answer 5

Small
- Curative: Surgical resection/EMR or ESD/ ablation

Large
- Curative: neoadjuvant chemo with radical resection

Palliative
- Stenting for dysphagia (self-expanding metal stenting, SEMS)
- External beam radiotherapy
- Systemic chemo for symptomatic metastasis

Question 6

Gastric cancer red flag symptoms (5)

Answer 6

• Chronic GI bleeds
• Unintentional weight loss
• Early satiety
• Iron def anaemia
• Epigastric mass

Question 7

Types of gastric cancer (4)

Answer 7

Adenocarcinoma (most common)

Connective tissue
- GIST (GI stromal tumours): Leiomyoma, leiomyosarcoma

Neuroendocrine:
- Caricinoid

Lymphoma

Question 8

Adenocarcinoma treatment

Answer 8

Neoadjuvant chemo+ surgery
- Antrectomy
- Total gastrectomy

Question 9

Rhabdomyosarcoma

Answer 9

Malignant tumour of skeletal muscle wall of the oesophagus
- Very rare

Question 10

Signs and symptoms of oesophageal tumour
- Local
- Disseminated disease

Answer 10

Local
- Dysphagia (if >45, assume is tumour unless otherwise)
- Previous GORD (adenocaricnoma) symptoms
- Haematemesis,
- Dysphonia (recurrent laryngeal n. palsy)
- Persistent cough, haemoptysis (tracheal invason)
- Horner syndrome (sympathetic chain invasion)

Disseminated disease
- Cervical lymphadenopathy
- Hepatomegaly
- Epigastric mass (para-aortic mets)

Question 11

Diagnosis of oeosphageal cancer

Answer 11

Oesophagoscopy and biopsy

Question 12

Staging of oesophageal cancer
- Local
- regional
- Disseminated

Answer 12

Local
- Endoluminal ultrasound

Regional
- CT scan

Disseminated
- PET may be used

Question 13

Gastric adenocarcinoma
- Incidence age
- Sex
- Risk factors

Answer 13

Age >50
- M>F= 3:1

Risk
- Diet rich in nitrosamines
- chronic atrophic gastritis
- Chronic ulcers from H pylori
- Blood group A

Question 14

Signs of gastric cancer

Answer 14

Weight loss

Palpable epigastric mass

Palpable supraclavicular lymph node
- Troisier’s sign (Virchow’s node)

Anaemia

Upper GI bleed: melaena,

Question 15

Symptoms of gastric cancer

Answer 15

Dyspepsia

Weight loss, anorexia, lethargy

Dysphagia

Question 16

Staging of gastric cancer

Answer 16

Thorax and adominal CT
- Distant mets
- Local nodes

Endoluminal US
- Local disease

Laparoscopy
- Exclude mets for potential resection

Question 17

Early gastric cancer treatment
- Indication
- Procedures

Answer 17

Indication
- Stage T1 or 2, N0/1, no mets

Curative resection
- Radical gastrectomy (neoadjuvant chemo)

Question 18

Late gastric cancer treatment
- Indication
- Procedures

Answer 18

Indication
- stage T3+, N2, mets

Resection with neoadjuvant chemo
- Unlikely to be curative

Palliation
- Local ablation for symptom control
- Chemo do disseminate disease

Question 19

Indication of urgent cancer referral for upper GI cancer

Answer 19

Anyone with upper abdominal mass

Question 20

Indication for urgent endoscopy for suspected gastric cancer

Answer 20

Dysphagia

Age 55+ with weight AND
- dyspepsia
- Upper abdominal pain
- reflux

Question 21

Indication for non-urgent endoscopy for suspected gastric cancer

Answer 21

Haematemesis

Age 55+ and:
- upper abdominal pain with low Hb
- treatment resistant dyspepsia
- raised platelets (and weight loss/ vomiting/ nausea/ dyspepsia)

Question 22

What type of gastric cancer can be eradicated with antibiotics

Answer 22

Early stage MALT
- H. pylori eradication

Question 23

What syndrome is associated with squamous cell carcinoma of the oesophagus

Answer 23

Plummer Vinson syndrome