*Oesophageal and Stomach Disorders (lectures 1 and 2) Flashcards
What are the 2 possible types of oesophageal cancer?
What is the most common?
Where is each more likely to occur?
what are the main things that increase the incidence of each type?
Adenocarcinoma (distal oesophagus) - more common - GORD
Squamous cell carcinoma (proximal oesophagus) - smoking and drinking
signs and symptoms of oesophageal cancer? (8)
dysphagia: where the patient feels food sticking isn't necessarily where the tumour is odynophagia upper GI haemorrhage anaemia weight loss retrosternal pain if upper tumour, cough and hoarseness
What should be performed if you suspect oesophageal cancer? e.g. presence of dysphagia
An urgent upper GI endoscopy
Also perform a colonoscopy if the patent presents with anaemia
What 3 things should be done to help choose treatment for oesophageal and gastric cancers?
Determine treatment intent
Assess patient fitness
Accurate staging
What is performed to accurately stage an oesophageal cancer?
CT thorax/ abdomen - if normal perform tests below
CT/PET, EUS, Laparoscopy (can spread intra-abdominally causing little seedlings in the abdomen - laparoscopy searches for this)
search hard for metastatic disease
if metastases present = palliative care
Palliative treatment options for oesophageal cancer? (3)
Chemotherapy
Radiotherapy
Stenting - not very pleasant to swallow with
Treatment options for oesophageal cancer that can be potentially cured?
Surgery with or without NAC - offers better cure rates for early disease
Radical chemoradiotherapy - complications are more manageable
What are the adverse prognostic factors for oesophageal cancer? (3)
Oesophageal obstruction
Tumour longer than 5cm
Metastatic disease
Staging of oesophageal cancer using TNM?
Tis = carcinoma in situ T1 = invading lamina propria/ submucosa T2 = invading muscularis propria T3 = Invading adventitia T4 = invasion of adjacent structures Nx = nodes cannot be assessed NO = no node spread N1 = regional node metastasise M0 = no distant spread M1 = distant metastasis
What types of gastric cancers do you get? (5)
What is the most common type?
Adenocarcinoma - commonest type Rarer: lymphoma - better prognosis Gastrointestinal Stomal Tumours - rarely metastasise = better prognosis Squamous cell carcinoma Neuroendocrine tumours
Signs and symptoms of gastric cancer? (10)
Dysepsia Upper GI bleeding Anaemia weight loss Abdominal mass Anorexia/ early satiety vomiting Hepatomegaly jaundice ascites
How do you accurately stage a gastric cancer?
CT thorax/ abdomen
Laparoscopy/ EUS
Palliative treatment for gastric cancer? (3)
Chemotherapy
Radiotherapy
Surgical palliation e.g. for obstruction
(Trastuzamab for Her-2 positive tumours)
Treatment for potentially curable gastric cancer?
surgery with or without NAC
surgery based treatment is the only potentially curative option
radiotherapy is not a treatment option for gastric cancers as the stomach is too big an organ and therefore you would poison the patient with radiotherapy
Adverse prognostic factors for gastric cancer (6)?
metastatic disease short history advanced age proximal lesions locally advanced lesion superficial gross appearance (limits plastica)
What is gastro-oesophageal reflux disease?
Reflux of stomach contents which causes troublesome symptoms and/or complications
What causes GORD? (3)
Lower oesophageal sphincter doesnt work properly
Increase in intra-abdominal pressure
Gastric acid hyper secretion
What type of people have a higher chance of getting GORD? (4)
Pregnant people
Obese people
Smokers
Increased association with alcohol
Symptoms of GORD?
Heartburn (burning retrosternal discomfort after meals, lying, stooping or straining) belching acid brash (acid/ bile regurgitation) Waterbrash (increased salivation) odynophagia (pain on swallowing e.g. from oesophagitis) nocturnal asthma chronic cough laryngitis sinusitis
Complications of GORD?
Oesophagitis Ulceration Benign stricture Iron-deficiency Barrett’s oesophagus = increased chance of oesophageal cancer
What type of classification is used to classify GORD?
Los Angeles Classification
Loss Angeles Classification?
“mucosal break” = a well-demarcated area of slough/ erythema) - used to encompass the old terms ulceration and erosion
1 = more than or equal to 1 mucosal break, 5mm long but not extending beyond 2 mucosal fold tops
3 = mucosal break continuous between the tops of 2 or more mucosal folds but which involves less than 75% of the oesophageal circumference
4 = mucosal break involving greater than or equal to 75% of the oesophageal circumference
Treatments fo GORD?
Physically repair the defective valve (surgery)
H2 receptor antagonists
PPIs
Anti-acids
What causes achalasia?
Lower oesophageal sphincter fails to relx
Symptoms of achalasia? (4)
Dysphagia
regurgitation
Substernal cramps
Weight loss
Diagnosis of achalasia?
CXR (fluid level in dilated oesophagus) Barium swallow (dilated tapering oesophagus
Treatment of achalasia?
endoscopic balloon dilation
Heller’s Cardiomyotomy
then PPRI
Botulinum toxin injections (non-invasive - required every few months)
calcium channel blockers and nitrates also relax the sphincter
long standing achalasia may cause oesophageal cancer
