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GI > Oesophageal and Gastric Cancer > Flashcards

Oesophageal and Gastric Cancer Flashcards

1
Q

What types of cancer affects the oesophagus

A

Squamous cell

Adenocarcinoma = most common

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2
Q

What is TNM staging of oesophageal cancer

A 
T1A = mucosa
T1b = sub-mucosa
T2 = muscle 
T3 = adventitia (outer layer) 
T4 = attached to organ e.g. aorta / pleura / trachea
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3
Q

Why is important o differentiate between T1 and T2 and how do you do this

A

Different treatment

EUS used if local disease no mets

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4
Q

Why does oesophagus not have serosa

A

Not covered by peritoneum

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5
Q

What is a squamous cell tumour like

A

Large occluding
Proximal and middle
Dysplasia before
Wart like

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6
Q

What is an adenocarcinoma like

A

Distal oesophagus as due to GORD / Barret
Present late
Fleshy

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7
Q

What is the most common presenting symptom

A

Progressive dysphagia

Solid then liquid

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8
Q

What are other symptoms /

A 
Weight loss
Anorexia
Vomiting during eating 
Odynophagia
Chest pain / heart burn 
Haematemesis 
Cough / hoarse 
Pneumonia due to regurgitation 
Vocal cord paralysis
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9
Q

What causes pneumonia

A

Trachea-oesophageal fistula or regurgitation

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10
Q

What causes cough / hoarse / vocal cord paralysis

A

Damage to L recurrent laryngeal nerve or trachea invaded

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11
Q

Where does oesophageal cancer spread too

A

Liver in adenocarcinoma
Brain
Lungs
Bone

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12
Q

What are other complications of oesophageal cancer

A

Ulceration
Perforation
Abscess due to perforation
Stricture

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13
Q

What are the RF for oesophageal cancer

A 
Age 
Smoking
Alcohol 
Diet 
HPV
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14
Q

What is adenocarcinoma associated with

A 
Male 
Caucasian
Obesity - hernia 
GORD 
Barret's
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15
Q

What is squamous associated with

A

Diet
Achalasia
Plummer Vinson Syndrome

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16
Q

What is Plummer Vinson Syndrome

A

Anaemia - iron deficient
Atrophic glossitis
Dysphagia secondary to web

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17
Q

What is gold standard for Dx oesophageal cancer

A

Endoscopy + biopsy

18
Q

What else can you do

A

Barium swallow - used for motility but may pick up

EUS with CT / MRI to stage

19
Q

How do you stage

A 
FBC, U+E, LFT
CT CAP 
MRI
Laparoscopy if suspicion of peritoneal spread 
Bone scan
20
Q

What do you do if laparotomy -ve

A

PET

If primary does not light up then no mets will

21
Q

How do you treat dysplasia

A

Endoscopic ablation

22
Q

How do you treat 1a

A

Endoscopic mucosal reaction
Can’t do for 1b
Mucosa won’t separate from sub-mucosa

23
Q

What do you do for T1b / T2

A

Neoadjuvant Chemo
Surgical oesophagostomy
Radical RT / chemo

24
Q

What is only curative for Adenocarcinoma

A

Surgery

25
Q

Why neoadjuvant chemo

A

Most upper GI presents with mets

26
Q

What do you do for palliation which is 70%

A 
Stent
Laser
PEG
Nutrition
Intubation
Chemo / RT
27
Q

What do you do if Plummer Vinson

A

Iron supplement

Dilatation of web

28
Q

What are complications of surgery

A 
Chronic volume reflux 
Infection
Anastomotic leak = mediastinitis
Arrythmia
Lose LOS - small meals often
Perforation
General risks
29
Q

What do you get after op

A

Feeding jejuonstomy to allow time to heal

30
Q

How does gastric cancer arise

A

Gastritis
Intestinal metaplasia
Dysplasia
Cancer

31
Q

What causes

A

H.ployri

Unknown

32
Q

What are the RF

A 
Male 
>55
HNPCC / FAP
Smoking
H.pyloi
Ulcer
Previous gastric resection
Polyps 
FH
Blood group A
Gastritis
Reflux
Pernicious anaemia
Low fibre, high flat
33
Q

What are the symptoms

A 
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
34
Q

How does gastric cancer spread

A

Direct
Lymphatic
Blood to liver
Trans-colemic within peritoneal cavity

35
Q

What is 1st line investigation

A

Endoscopy + biopsy

Barium swallow may show

36
Q

How do you stage

A

EUS for depth
CT.MRI for staging
laparoscopy for locally advanced / cytology of peritoneal washing
PET CT

37
Q

How do you treat

A

Neo-adjuvant chemo
Gastrectomy
Surgical palliation for obstruction / pain

38
Q

What do you have to do after surgery

A

Small meals often

Vitamin supplement

39
Q

What are complications after surgery

A 
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
40
Q

What is dumping syndrome

A 
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

GI (29 decks)

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