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3A week 1 - upper GI tract > oesophageal malignancies > Flashcards

oesophageal malignancies Flashcards

1
Q

what are the 3 main categories for oesophago-gastric cancers

A
  1. oesophageal malignancy
  2. oesophagogoastric junction malignancy
  3. gastric malignancy
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2
Q

what vertebrae levels does the cervical oesophagus reside at

A

C6 - T1

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3
Q

what vertebrae levels does the thoracic oesophagus reside at

A

T1-T10

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4
Q

what vertebrae levels does the abdominal oesophagus reside at

A

T11 - T12

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5
Q

what narrowings occur at the cervical oesophagus level (2)

A
  1. upper oesophageal sphincter
  2. cricoid cartilage
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6
Q

what narrowings occur at the thoracic oesophagus level (2)

A
  1. aortic bifurcation
  2. tracheal bifurcation
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7
Q

what narrowings occur at the abdominal oesophagus level (2)

A
  1. lower oesophageal sphincter
  2. diaphragm
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8
Q

what are the 4 main layers of the oesophagus (in to out)

A
  1. mucosa (lamina propria, muscularis mucosae)
  2. submucosa
  3. muscularis externae
  4. adventitia
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9
Q

what is the appearance of a normal oesophagus on endoscopy

A

lined by pale pink stratifies squamous epithelium down to the stomach where after the Z line the mucosa is salmon coloured

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10
Q

why is the oeophagus lines with stratified squamous cells

A

these cells are the most resistant to damage from noxious substances that are ingested

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11
Q

what are the 2 main histological types of oesophageal carcinoma

A
  1. adenocarcinoma (most common type in western world)
  2. squamous cell carcinoma (most common type worldwide)
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12
Q

how is the distribution of oesophageal cancer seen across the world

A

geographically - there is an oeophageal cancer belt that stretches from NE china to iran, even within countries themselves there is geographical distribution

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13
Q

invasion of what layer indicates more advanced oesophageal cancer

A

muscularis propria

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14
Q

what derm condition is associated with aggressive oesophageal SCC

A

palmoplantar keratoderma

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15
Q

risk factors for squamous cell carcimoa of the oesophagus (8)

A
  1. cigarette smoking
  2. alcohol
  3. previous head/neck cancer (usually smokers)
  4. low socioeconomic class
  5. previous radiotherapy
  6. HPV
  7. achalasia
  8. coeliac disease
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16
Q

how does intestinal metaplasia occur (barrett’s oesophagus)

A

acid reflux causing damage to the oesophagus

17
Q

what is metaplasia

A

adaptive change in cell type to the local environment -> one fully differentiated cell type changes to another fully differentiated cell type

18
Q

what is the commonest location of oesophageal ACC

A

oesophagogastric junction

19
Q

risk factors for oesophgeal ACC (5)

A
  1. barrett’s oesophagus
  2. being male
  3. smoking
  4. obesity
  5. caucasian
20
Q

what are the stages from squamous epithelium -> oesophageal ACC (5)

A
  1. squamous epithelium
  2. non-dysplastic barrett’s oesophagus
  3. low grade dysplasia
  4. high grade dysplasia (treat as if cancerous)
  5. T1 oesophageal ACC
21
Q

what does a nodule in barrett’s oesophagus indicate

A

either high grade dysplasia or cancer

22
Q

what is the curative treatment for T1a oesophageal ACC

A

endoscopic mucosal resection (if T1b + then further surgery will be needed)

23
Q

what size ACC is suitable for endoscopic mucosal resection

A

<2cm, non ulcerated

24
Q

oesophageal cancer presentation (5)

A
  1. progressive dysphagia (if presenting w this assume cancer until proven otherwise!)
  2. change to liquid diet
  3. weight loss
  4. regurgitation
  5. presistant reflux not responding to PPI
25
Q

investigations for diagnosis of oesophageal cancer

A
  1. upper GI endoscopy
  2. biopsies x8!
  3. CT scan (T3 onwards)
26
Q

in whom might a barium swallow still be used in when suspicious of cancer

A

very frail patients who cannot tolerate OGD

27
Q

what are the 2 pathways for oesophageal cancer treatment

A
  1. curative - chemo + surgery
  2. palliative (if metastatic) - chemo + stent
28
Q

components of the curative pathway for oesophageal cancer

A
  1. 4 cycles of chemotherapy -> systemically to prevent risk of recurrence as cancerous cells may be present elsewhere
  2. surgery
  3. adjuvant chemo
29
Q

examples of benign oesophagea tumours (5)

A
  1. leiomyoma (commonest)
  2. duplication cyst
  3. fibrovascular polyps
  4. squamous cell papillomas
  5. granular cell tumours
30
Q

what is a leiomyoma

A

a smooth muscle tumour (benign) that arises from the muscularis propria and generally occurs in the mid/distal oesophagus -> account for 50% of benign oesophageal tumours

31
Q

risks for gastric cancer (9)

A
  1. male gender
  2. age
  3. ethnicity (east asian)
  4. H.pylori
  5. obesity
  6. cigarette smoking
  7. pernicious anaemia
  8. previous gastrectomy
  9. gastric polyps
32
Q

gastric cancer presentation (6)

A
  1. iron deficency anaemia
  2. early satiety
  3. weight loss
  4. abdominal pain
  5. reflux
  6. non-healing gastric ulcer
33
Q

emergency presentation of gastric cancer (4)

A
  1. haematemesis/melaena (i.e. upper GI bleed)
  2. gastric outlet obstruction
  3. perforated gastric ulcer
  4. disseminated disease e.g. ascites
34
Q

what is linitis plastica

A

morphological variant of diffuse stomach cancer in which the stomach wall becomes thick and rigid

35
Q

investigations for gastric cancer (3)

A
  1. endoscopy
  2. biopsies/histology
  3. urgent CT (chest, abdo, pelvis)
36
Q

on the curative pathway when is periop chemo forgone in favour of going straight to gastrectomy

A

aged>80 or many co-morbidities

37
Q

what does achalasia increase the risk of

A

oesophageal SCC

38
Q

4 characteristics of splenectomy on blood film

A
  1. Howell- Jolly bodies
  2. Pappenheimer bodies
  3. Target cells
  4. Irregular contracted erythrocytes

3A week 1 - upper GI tract (7 decks)

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