Oesophageal and Gastric Cancer Flashcards
What are the 4 surgical divisions of the oesophagus?
Cervical
Upper Thoracic
Middle Thoracic
Lower Thoracic/Gastro-Oesophageal Junction
What are the 2 types of oesophageal cancer?
Squamous cell carcinoma
Adenocarcinoma
What parts of the oesophagus do squamous cell carcinoma and adenocarcinoma affect?
- SQUAMOUS - Cervical to middle thoracic
- ADENOCARCINOMA - Lower thoracic to abdominal oesophagus
What are the risk factors for squamous cell carcinoma?
Male
Old age
Alcohol
Smoking
Hot beverages
What are the risk factors for adenocarcinoma?
Male
Old age
Obesity
Reflux
Barrett’s
What is Barrett’s oesophagus?
Change in any portion of the normal squamous oesophageal epithelium to a metaplastic columnar epithelium.
Describe the progression from GERD to adenocarcinoma.
- GERD (Reflux)
- Barrett’s
- Low grade dysplasia
- High grade dysplasia
- Adenocarcinoma
How is Barrett’s oesophagus treated?
Radiofrequency treatment
What are the symptoms of oesophageal cancer?
- Pressure on chest
- Difficulty swallowing
- Indigestion and heartburn
- Weight loss
What is used to diagnose and stage oesophageal cancer?
Endoscopy
CT chest abdomen pelvis
PET
Staging laparoscopy
EUS
Name some ways oesophageal cancer is treated and when it is used.
- Endoscopic treatment - for early cancer in patients with positive prognosis. Less frequent - because hard to diagnose early on
- Oncological and surgical treatment - for advanced cancer in patients with worse prognoses
- Palliative care - when too late to operate - stabilises disease and treats symptoms
When is 2-stage oesophagectomy (surgery) used?
- Goes to chest and abdomen
- For cancers in lower oesophagus and GOJ
- More frequent in adenocarcinoma
When is 3-stage oesophagectomy (surgery) used?
- Goes to neck, chest and abdomen
- For cancers in superior and middle oesophagus
- More frequent in squamous cell carcinoma
What are the 3 types of surgical access in surgical treatment of the oesophagus?
- Open surgery (laparotomy/thoracotomy)
- Laparoscopic
- Robotic
What is usually done during oesophageal cancer palliative treatment?
- Nutrition
- Dysphagia (unable to swallow) ➔ oesophageal stent
- Pain control
- Palliative chemotherapy/radiotherapy
What are the routes of treatment for someone with squamous cell carcinoma?
- Endoscopic (if early cancer)
- Surgery
- Chemo-radiotherapy + surgery
- Curative chemoradiotherapy
What are the routes of treatment for someone with adenocarcinoma?
- Endoscopic (if early cancer)
- Surgery
- Chemotherapy and/or radiotherapy alongside surgery
What are the main challenges in treating oesophageal cancer?
- Lack of awareness
- Need for promotion of screening
- Delayed diagnosis
- Surgery is very invasive
- Poor survival rates
- Association of Barrett’s with cancer
What are the risk factors for gastric cancer?
Male
>50 years
Low socioeconomic status
Helicobacter pylori
EBV
Smoking
Drinking
Obesity
Atrophic gastritis (autoimmune)
Family history
Previous gastric surgery
What are the types of gastric cancer?
- ADENOCARCINOMA - Inestinal or diffuse types
- Lymphoma
- GIST, Neuroendocrine
How can chronic superficial gastritis progress to cancer?
- Intestinal metaplasia
- Dysplasia
- Gastric cancer
What is used to diagnose and stage gastric cancer?
Endoscopy
CT chest abdomen pelvis
Staging laparoscopy
List some symptoms of gastric cancer.
- Weight loss
- Vomiting blood or blood in stool
- Poor appetite
- Heartburn
- Nausea
- Stomach pain
- Persistent vomiting and indigestion
How can gastric cancer be treated?
- Endoscopic treatment
- Curative treatment - surgery and/or chemotherapy
- Palliative care
What are the 2 types of chemotherapy?
- Neoadjuvant (before surgery)
- Adjuvant (after surgery)
Give examples of surgical treatment for benign tumours leading to gastric cancer
- Wedge resection
- Sleeve resection
- Distal gastrectomy
Give examples of surgical treatment for adenocarcinoma leading to gastric cancer
- DISTAL TUMOURS - Subtotal gastrectomy
- PROXIMAL TUMOURS - Total gastrectomy
