Oesophago-gastric cancer

Question 1

What happens to the cells of the lower oesophagus with reflux disease and why?

Answer 1

The squamous epithelium turn to columnar cells to try and resist the acidic environment

Question 2

What can occur with persistant reflux and what can this cause?

Answer 2

Barratts oesophagus leading to adenocarcinoma

Question 3

What causes squamous cell carcinoma?

Answer 3

excessive use of smoking or alcohol

Question 4

Name the 3 changes in cells leading to adneocarcinoma

Answer 4

Metaplasia, dysplasia, adenocarcinoma

Question 5

How does gastric adenocarcinoma arise as?

Answer 5

Presence of H Pylori combined with other genetic factors

Question 6

Where do Gastro Intestinal stomal tumours develop

Answer 6

In the wall of the stomach - not the lining of the epithelium

Question 7

Name the 3 types of gastric cancer

Answer 7

Adenocarcinoma
Lymphoma
GISTs

Question 8

What are the 3 types of Junctional Cancers and what type of cancers are they?

Answer 8

Oesophageal
True junctional
Gastric
All adenocarcinomas

Question 9

What are the signs and symptoms of oesophageal cancer

Answer 9

Dysphagia
Odynophagia
Haematemesis, Regurgitation, dysphonia
Weight loss
Adenopathy, pleural effusions, hepatomegaly (metastasis)
Paraneoplastic syndrome
Lymphadenopathy in the superclavicular junction around the carotid arteries

Question 10

What are the signs and symptoms of gastric cancer?

Answer 10

Dyspepsia - abdo pain, emesis, anorexia, dysphagia 
Upper GI haemorrhage
Weight loss
Abdo mass
Jaundice (if metastasis)
Paraneoplastic syndromes

Question 11

How can we diagnose oesophageal cancer

Answer 11

Weight loss
Lymph nodes
Liver

Upper GI endoscopy AND BIOPSY!
Barium meal
CT or MRI of chest and abdo
Endoscopic ultrasound for patients who are likely to rquire surgery

Question 12

What does an Endoscopic ultrasound show?

Answer 12

The lymph node location and state

Question 13

How can we diagnose gastric cancer

Answer 13

Weight loss 
lymph nodes 
Abdominal mass
Upper GI endoscopy AND BIOPSY
Barium meal
CT scan

Question 14

What are the alarm features of GI cancer

Answer 14

Over 55 years
Dysphagia
Evidence of GI blood loss
Persistent vomiting 
Unexplained weight loss
Upper abdominal mass
Anaemia

Question 15

WHat is the life expectancy when GI cancer has metastasised

Answer 15

1- 3 months on average

Question 16

What is the treatment for oesophageal treatment?

Answer 16

Palliation of oesophageal obstruction and improve survival
Only chance of cure is surgery
Removal of oesophagus and lymph nodes

Question 17

Who is not suitable for surgery for oesophageal cancer

Answer 17

50% of patients
Not T4 or M1 diagnosis
Not long tumours
Not cervical lymph node patients

Question 18

What are the contraindications to surgery for oesophageal cancer

Answer 18

Direct invasion of adjacent structures (trachea or bronchus)
Fixed cervical lymph nodes
Widespread metastases
Poor general health

Question 19

What are the other forms of treatment for oesophageal cancer?

Answer 19

Palliative Radiotherapy 
Intubation / stents
Canalisation - dilation
Photo-dynamic therapy 
Alcohol injections (dry up cells)
Terminal care

Question 20

What is the treatment options for gastric cancer?

Answer 20

SUrgery - palliation of symptoms 
improved survival 
via an abdo op
remove involved organs
Radiotherapy
Chemotherapy 
Intubation of proximal lesions

Question 21

What is the prognosis of oesophageal cancer?

Answer 21

11% 5 year survival rate for all patients

Patients who have surgery have a much higher survival rate

Question 22

What is the prognosis of gastric cancer?

Answer 22

15% 5 year survival rate for all patients (higher than oesophageal)
Particularly in young and old
Young females - the tumours are particularly agressive as they feed on female hormones - surgery does not improve survival rate