Oesophago-gastric cancer Flashcards
What happens to the cells of the lower oesophagus with reflux disease and why?
The squamous epithelium turn to columnar cells to try and resist the acidic environment
What can occur with persistant reflux and what can this cause?
Barratts oesophagus leading to adenocarcinoma
What causes squamous cell carcinoma?
excessive use of smoking or alcohol
Name the 3 changes in cells leading to adneocarcinoma
Metaplasia, dysplasia, adenocarcinoma
How does gastric adenocarcinoma arise as?
Presence of H Pylori combined with other genetic factors
Where do Gastro Intestinal stomal tumours develop
In the wall of the stomach - not the lining of the epithelium
Name the 3 types of gastric cancer
Adenocarcinoma
Lymphoma
GISTs
What are the 3 types of Junctional Cancers and what type of cancers are they?
Oesophageal
True junctional
Gastric
All adenocarcinomas
What are the signs and symptoms of oesophageal cancer
Dysphagia
Odynophagia
Haematemesis, Regurgitation, dysphonia
Weight loss
Adenopathy, pleural effusions, hepatomegaly (metastasis)
Paraneoplastic syndrome
Lymphadenopathy in the superclavicular junction around the carotid arteries
What are the signs and symptoms of gastric cancer?
Dyspepsia - abdo pain, emesis, anorexia, dysphagia Upper GI haemorrhage Weight loss Abdo mass Jaundice (if metastasis) Paraneoplastic syndromes
How can we diagnose oesophageal cancer
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
What does an Endoscopic ultrasound show?
The lymph node location and state
How can we diagnose gastric cancer
Weight loss lymph nodes Abdominal mass Upper GI endoscopy AND BIOPSY Barium meal CT scan
What are the alarm features of GI cancer
Over 55 years Dysphagia Evidence of GI blood loss Persistent vomiting Unexplained weight loss Upper abdominal mass Anaemia
WHat is the life expectancy when GI cancer has metastasised
1- 3 months on average
What is the treatment for oesophageal treatment?
Palliation of oesophageal obstruction and improve survival
Only chance of cure is surgery
Removal of oesophagus and lymph nodes
Who is not suitable for surgery for oesophageal cancer
50% of patients
Not T4 or M1 diagnosis
Not long tumours
Not cervical lymph node patients
What are the contraindications to surgery for oesophageal cancer
Direct invasion of adjacent structures (trachea or bronchus)
Fixed cervical lymph nodes
Widespread metastases
Poor general health
What are the other forms of treatment for oesophageal cancer?
Palliative Radiotherapy Intubation / stents Canalisation - dilation Photo-dynamic therapy Alcohol injections (dry up cells) Terminal care
What is the treatment options for gastric cancer?
SUrgery - palliation of symptoms improved survival via an abdo op remove involved organs Radiotherapy Chemotherapy Intubation of proximal lesions
What is the prognosis of oesophageal cancer?
11% 5 year survival rate for all patients
Patients who have surgery have a much higher survival rate
What is the prognosis of gastric cancer?
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
