Oesophago-gastric cancer Flashcards
What are the layers of normal oesophageal wall?
Mucosa (epithelium, LP, muscularis mucose)
Submucosa
Muscularis propria
Adventitia / serosa
Describe the evolution fo Barrett’s oesophagus into an adenocarcinoma.
Squamous oesophagus chronic inflammation Barrett's metaplasia Low-Grade dysplasia High-grade dysplasia Invasive adenocarcinoma
How many biopsies must be positive for diagnosis of oesophageal cancer to be confirmed?
at least 6
What tests are done to stage oesophageal cancer?
CT chest, abdomen and pelvis.
PET-CT - more sensitive for distal nodal disease (metastases).
Endoscopic ultrasound - more sensitive for regional (local) nodal disease.
What does T refer to in TNM scale?
How far the primary tumour has grown into the wall of the oesophagus and nearby organs.
T1-4
What does N stand for in TNM?
The spread of the cancer to nearby lymph nodes (N0-1)
what does the M stand for in TNM?
indicates whether the cancer has metastasised (M0-1)
How would you treat a SCC of the oesophagus?
Squamous cells are sensitive to radiotherapy so localise it with radical radiotherapy.
(no surgery)
How would you treat an adenocarcinoma?
Endoscopic resection is a possibility depending on stage.
If no evidence of metastases, then consider oesophagectomy ± neoadjuvant chemotherapy
What is the most common cause of gastric cancer?
Helicobacter pylori (60%)
Does smoking increase the risk of gastric cancer?
yes
What test diagnoses gastric cancer?
endoscopy
What are some of the signs and symptoms of gastric cancer?
indigestion, fatigue, bloating, abdominal pain, weight loss
How is gastric cancer staged?
CT - abdomen, pelvis and chest.
CT-PET - used to identify distal nodal disease (metastases)
Endoscopic ultrasound - more localised nodal disease.
Which has the worse prognosis: gastric or oesophageal cancer?
gastric
