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Gastro > Oesophageal and Gastric Cancer > Flashcards

Oesophageal and Gastric Cancer Flashcards

1
Q

What types of cancer affects the oesophagus [2]

A

Squamous cell

Adenocarcinoma = most common

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2
Q

What is TNM staging of oesophageal cancer. Describe ‘T’ [5]

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 does oesophagus not have serosa

A

Not covered by peritoneum

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4
Q

Morphology squamous cell tumour [4]

A

Large occluding
Proximal and middle
Dysplasia before
Wart like

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5
Q

Morphology adenocarcinoma [3]

A

Distal oesophagus as due to GORD / Barret
Present late
Fleshy

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6
Q

What is the most common presenting symptom [2]

A

Progressive dysphagia

Solid then liquid

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7
Q

What are other symptoms [5]

A 
Weight loss, Anorexia
Vomiting during eating, Haematemesis
Chest pain / heart burn, Odynophagia 
Cough / hoarse, Vocal cord paralysis 
Pneumonia
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8
Q

What causes pneumonia

A

Trachea-oesophageal fistula

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9
Q

What causes cough / hoarse / vocal cord paralysis

A

Damage to L recurrent laryngeal nerve

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10
Q

Where does oesophageal cancer spread to [4]

A

Liver in adenocarcinoma
Brain
Lungs
Bone

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11
Q

What are other complications of oesophageal cancer [4]

A

Ulceration
Perforation
Abscess due to perforation
Stricture

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12
Q

What are the RF for oesophageal cancer [3]

A

Smoking
Alcohol
HPV

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13
Q

What is adenocarcinoma associated with [5]

A 
Male 
Caucasian
Obesity - hernia 
GORD 
Barret's
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14
Q

What is squamous associated with [3]

A

Diet
Achalasia
Plummer Vinson Syndrome

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15
Q

What is Plummer Vinson Syndrome [3]

A

Anaemia - iron deficient
Atrophic glossitis
Dysphagia secondary to web

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16
Q

What is gold standard for Dx oesophageal cancer [2]

A

Endoscopy + biopsy

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17
Q

What else can you do [2]

A

Barium swallow - used for motility but may pick up

EUS with CT / MRI

18
Q

Staging investigations [4]

A 
FBC, LFT
CT CAP (chest, abdo, pelvis)
MRI
Laparoscopy if suspicion of peritoneal spread 
Bone scan
19
Q

What do you do if laparotomy -ve

A

PET

If primary does not light up then no mets will

20
Q

How do you treat dysplasia

A

Endoscopic ablation

21
Q

Management T1a [3]

Can this be applied to T1b? [2]

A

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

22
Q

Management T1b / T2 [3]

A

Neoadjuvant Chemo
Surgical oesophagostomy
Radical RT / chemo

23
Q

What is only curative for Adenocarcinoma

A

Surgery

24
Q

What are complications of bariatric surgery [5]

A 
DVT / PE
Infection
Malnutrition 
Vitamin deficinecy
Hair loss
25
Q

Rationale for neoadjuvant chemo

A

Most upper GI presents with mets

26
Q

What do you do for palliation [6]

A 
Stent
Laser
PEG, Nutrition
Intubation
Chemo / RT
27
Q

What do you do if there’s Plummer Vinson [2]

A

Iron supplement

Dilatation of web

28
Q

What are complications of surgery [6]

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

What do you get after op

A

Feeding jejunostomy to allow time to heal

30
Q

Pathogenesis of gastric cancer [4]

A

Gastritis
Intestinal metaplasia
Dysplasia
Cancer

31
Q

What causes

A

H.ployri

Unknown

32
Q

What are the RF of gastric cancer [9]

A 
Male, >55
Smoking
H.pylori  > atrophic gastritis
Gastritis, Reflux, Ulcer
Previous gastric resection
Blood group A
Pernicious anaemia > atrophic gastritis
Low SEC, High nitrate diet
Familial syndromes eg E cadherin abnormality
33
Q

What are the symptoms [7] and signs [5] of gastric cancer

A

Symptoms

  • Dyspepsia
  • Late presentation
  • Weight loss, anorexia
  • Dysphagia
  • N+V, bloating, early satiety
  • Malaena
  • Anemic symptoms

Signs

  • Epigastric mass
  • Jaundice, hepatomegaly
  • Ascites
  • Virchow’s node
  • Acanthosis nigricans
34
Q

How does gastric cancer spread [3]

A

Direct - within stomach, pancreas
Lymphatic - Virchow’s node
Blood to liver
Trans-colemic within peritoneal cavity - ovaries, umbilical

35
Q

What is 1st line investigation [2]

A

Endoscopy + biopsy

+/- Barium swallow

36
Q

How do you stage [4]

A

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

37
Q

How do you treat [3]

A

Neo-adjuvant chemo
Endoscopic resection if early stage
Gastrectomy with Roux-en-Y to prevent bile reflux

38
Q

What do you have to do after surgery [2]

A

Small meals often

Vitamin supplement

39
Q

What are complications after surgery

A 
Infection
Bleeding 
Vomiting 
Vitamin deficiency: B12 deficiency 
Iron deficiency, Osteoporosis
Impaired protein digestion as lack of pepsin
Lack of sterilisation 
Weight loss
Early satiety
Dumping syndrome
40
Q

What is dumping syndrome [6]

A 
Fluid shift and distention
Dizzy, Flush, Hypoglycaemia
Fast HR
N+V, Abdo pain
Diarrhoea as increased osmotic pull
41
Q

If palliative what is included in management [4]

A

Analgesia, PPI, secretion control
Chemo
Pyloric stenting
Bypass procedures - connect duodenum to stomach to bypass outlet obstruction

42
Q 
Zollinger elision syndrome
Ax [2]
Px [2]
Sxs [4]
Ix [2]
Mx [2]
A

Ax: gastrinoma in small intestine or pancreas, mostly malignant, assoc with MEN1
Px: gastrin increases HCl causing peptic ulceration and chronic diarrhea
Sxs: abdo pain, dyspepsia, steatorrhea, refractory ulcers
Ix: stomach pH <2, MRI/CT
Mx: high dose PPI, surgical resection

Gastro (17 decks)

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