Oesophageal and Gastric Cancer Flashcards
What types of cancer affects the oesophagus [2]
Squamous cell
Adenocarcinoma = most common
What is TNM staging of oesophageal cancer. Describe ‘T’ [5]
T1A = mucosa T1b = sub-mucosa T2 = muscle T3 = adventitia (outer layer) T4 = attached to organ e.g. aorta / pleura / trachea
Why does oesophagus not have serosa
Not covered by peritoneum
Morphology squamous cell tumour [4]
Large occluding
Proximal and middle
Dysplasia before
Wart like
Morphology adenocarcinoma [3]
Distal oesophagus as due to GORD / Barret
Present late
Fleshy
What is the most common presenting symptom [2]
Progressive dysphagia
Solid then liquid
What are other symptoms [5]
Weight loss, Anorexia Vomiting during eating, Haematemesis Chest pain / heart burn, Odynophagia Cough / hoarse, Vocal cord paralysis Pneumonia
What causes pneumonia
Trachea-oesophageal fistula
What causes cough / hoarse / vocal cord paralysis
Damage to L recurrent laryngeal nerve
Where does oesophageal cancer spread to [4]
Liver in adenocarcinoma
Brain
Lungs
Bone
What are other complications of oesophageal cancer [4]
Ulceration
Perforation
Abscess due to perforation
Stricture
What are the RF for oesophageal cancer [3]
Smoking
Alcohol
HPV
What is adenocarcinoma associated with [5]
Male Caucasian Obesity - hernia GORD Barret's
What is squamous associated with [3]
Diet
Achalasia
Plummer Vinson Syndrome
What is Plummer Vinson Syndrome [3]
Anaemia - iron deficient
Atrophic glossitis
Dysphagia secondary to web
What is gold standard for Dx oesophageal cancer [2]
Endoscopy + biopsy
What else can you do [2]
Barium swallow - used for motility but may pick up
EUS with CT / MRI
Staging investigations [4]
FBC, LFT CT CAP (chest, abdo, pelvis) 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
Management T1a [3]
Can this be applied to T1b? [2]
Endoscopic mucosal resection - Can’t do for 1b as Mucosa won’t separate from sub-mucosa
Management T1b / T2 [3]
Neoadjuvant Chemo
Surgical oesophagostomy
Radical RT / chemo
What is only curative for Adenocarcinoma
Surgery
What are complications of bariatric surgery [5]
DVT / PE Infection Malnutrition Vitamin deficinecy Hair loss
Rationale for neoadjuvant chemo
Most upper GI presents with mets
What do you do for palliation [6]
Stent Laser PEG, Nutrition Intubation Chemo / RT
What do you do if there’s Plummer Vinson [2]
Iron supplement
Dilatation of web
What are complications of surgery [6]
Chronic volume reflux Anastomotic leak = mediastinitis Arrhythmia Lose LOS - small meals often Perforation General risks
What do you get after op
Feeding jejunostomy to allow time to heal
Pathogenesis of gastric cancer [4]
Gastritis
Intestinal metaplasia
Dysplasia
Cancer
What causes
H.ployri
Unknown
What are the RF of gastric cancer [9]
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
What are the symptoms [7] and signs [5] of gastric cancer
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
How does gastric cancer spread [3]
Direct - within stomach, pancreas
Lymphatic - Virchow’s node
Blood to liver
Trans-colemic within peritoneal cavity - ovaries, umbilical
What is 1st line investigation [2]
Endoscopy + biopsy
+/- Barium swallow
How do you stage [4]
EUS for depth
CT or MRI
laparoscopy for locally advanced / cytology of peritoneal washing
PET CT
How do you treat [3]
Neo-adjuvant chemo
Endoscopic resection if early stage
Gastrectomy with Roux-en-Y to prevent bile reflux
What do you have to do after surgery [2]
Small meals often
Vitamin supplement
What are complications after surgery
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
What is dumping syndrome [6]
Fluid shift and distention Dizzy, Flush, Hypoglycaemia Fast HR N+V, Abdo pain Diarrhoea as increased osmotic pull
If palliative what is included in management [4]
Analgesia, PPI, secretion control
Chemo
Pyloric stenting
Bypass procedures - connect duodenum to stomach to bypass outlet obstruction
Zollinger elision syndrome Ax [2] Px [2] Sxs [4] Ix [2] Mx [2]
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
