Oesophageal and Gastric Cancer Flashcards
What types of cancer affects the oesophagus
Squamous cell
Adenocarcinoma = most common
What is TNM staging of oesophageal cancer
T1A = mucosa T1b = sub-mucosa T2 = muscle T3 = adventitia (outer layer) T4 = attached to organ e.g. aorta / pleura / trachea
Why is important o differentiate between T1 and T2 and how do you do this
Different treatment
EUS used if local disease no mets
Why does oesophagus not have serosa
Not covered by peritoneum
What is a squamous cell tumour like
Large occluding
Proximal and middle
Dysplasia before
Wart like
What is an adenocarcinoma like
Distal oesophagus as due to GORD / Barret
Present late
Fleshy
What is the most common presenting symptom
Progressive dysphagia
Solid then liquid
What are other symptoms /
Weight loss Anorexia Vomiting during eating Odynophagia Chest pain / heart burn Haematemesis Cough / hoarse Pneumonia due to regurgitation Vocal cord paralysis
What causes pneumonia
Trachea-oesophageal fistula or regurgitation
What causes cough / hoarse / vocal cord paralysis
Damage to L recurrent laryngeal nerve or trachea invaded
Where does oesophageal cancer spread too
Liver in adenocarcinoma
Brain
Lungs
Bone
What are other complications of oesophageal cancer
Ulceration
Perforation
Abscess due to perforation
Stricture
What are the RF for oesophageal cancer
Age Smoking Alcohol Diet HPV
What is adenocarcinoma associated with
Male Caucasian Obesity - hernia GORD Barret's
What is squamous associated with
Diet
Achalasia
Plummer Vinson Syndrome
What is Plummer Vinson Syndrome
Anaemia - iron deficient
Atrophic glossitis
Dysphagia secondary to web
What is gold standard for Dx oesophageal cancer
Endoscopy + biopsy
What else can you do
Barium swallow - used for motility but may pick up
EUS with CT / MRI to stage
How do you stage
FBC, U+E, LFT CT CAP MRI Laparoscopy if suspicion of peritoneal spread Bone scan
What do you do if laparotomy -ve
PET
If primary does not light up then no mets will
How do you treat dysplasia
Endoscopic ablation
How do you treat 1a
Endoscopic mucosal reaction
Can’t do for 1b
Mucosa won’t separate from sub-mucosa
What do you do for T1b / T2
Neoadjuvant Chemo
Surgical oesophagostomy
Radical RT / chemo
What is only curative for Adenocarcinoma
Surgery
Why neoadjuvant chemo
Most upper GI presents with mets
What do you do for palliation which is 70%
Stent Laser PEG Nutrition Intubation Chemo / RT
What do you do if Plummer Vinson
Iron supplement
Dilatation of web
What are complications of surgery
Chronic volume reflux Infection Anastomotic leak = mediastinitis Arrythmia Lose LOS - small meals often Perforation General risks
What do you get after op
Feeding jejuonstomy to allow time to heal
How does gastric cancer arise
Gastritis
Intestinal metaplasia
Dysplasia
Cancer
What causes
H.ployri
Unknown
What are the RF
Male >55 HNPCC / FAP Smoking H.pyloi Ulcer Previous gastric resection Polyps FH Blood group A Gastritis Reflux Pernicious anaemia Low fibre, high flat
What are the symptoms
Dyspepsia Persistent pain Early satiety Blaoting N+V Weight loss Melena Anaemia
Signs suggests incurable Upper abdominal mass HSM AScites Jaundice Obstruction Large left supraclavicular node (Virchow's) Acanthosis nigrican's
How does gastric cancer spread
Direct
Lymphatic
Blood to liver
Trans-colemic within peritoneal cavity
What is 1st line investigation
Endoscopy + biopsy
Barium swallow may show
How do you stage
EUS for depth
CT.MRI for staging
laparoscopy for locally advanced / cytology of peritoneal washing
PET CT
How do you treat
Neo-adjuvant chemo
Gastrectomy
Surgical palliation for obstruction / pain
What do you have to do after surgery
Small meals often
Vitamin supplement
What are complications after surgery
Infection Bleeding Vomiting B12 deficiency Iron deficiency Vitamin deficiency Impaired protein digestion as lack of pepsin Lack of sterilisation Bacterial overgrowth Malabsorption Osteoporosis / osteomalacia Weighth loss Early satiety Dumping syndrome
What is dumping syndrome
Fluid shift and distension as can't digest food so rapid transit Dizzy Flushing / sweating Fast HR N+V Abdo pain Hypoglycaemia due to rapid glucose absorption and insulin release Diarrhoea as increased osmotic pull
