Oesophagogastrectomy Flashcards
Oesophago-gastr-ectomy
removal of lower part of oesophagus and upper part of the stomach + Lymph nodes are also removed
(i.e. cancer has invaded both organs)
Neoadjuvant
treatment of a tumor with drugs before surgery to reduce the size of the tumor
Adjuvant
cancer chemotherapy employed after the primary tumor has been removed, which helps avoid recurrence
Oesophagoscopy
is the examination of the gullet (oesophagus) while you are under a general anaesthetic.
(to find the cause of dysphagia [difficulty swallowing] and lumps in the throat)
PET scan (Position Emission Tomography)
imaging test that uses a radioactive substances (tracer) to look for disease in the body.
[i.e. explores the possibility of cancer metastasis (spreading to other sites) is the most common type of PET scan in standard medical care (90% of current scans)]
Surgical access routes for an oesophagogastrectomy
Laparotomy
Thoracoabdominal
Transhiatal oesophagectomy
involves both an abdominal incision (laparotomy) and a cervical (neck) incision. (the thoracic cavity is not opened)
Transthoracic oesophagectomy
involves an abdominal incision and a thoracotomy (around the rib cage)
The choice of operation depends on the location of the tumor; the patient’s pulmonary function and the surgeon’s experience and preference; however, which one (Transhiatal or Transthoracic) may have more benefit and why?
Transhiatal oesophagectomy
Because the patient has not had the chest opened, there is less pain early after surgery; the patient can move about better as a result (up and walking the day after operation), and lung complications are less.
(typically discharged one week after the operation eating a soft diet.)
risk factors for development of oesophageal cancer
- Smoking and drinking alcohol
- Obesity
- Diet (Processed food and red meat)
- Pollutants and chemicals exposure
- having GERD (gastrooesophageal acid reflux)
Signs and Symptoms for oesophageal cancer
- Cachexia (unexplained loss of body weight, muscle mass, fatigue, weakness, and significant loss of appetite)
- Hemoptysis (coughing up blood)
- Dysphagia (difficulty swallowing)
- Bone pain (2nd metastasis)
every two years, aged _____ to ____ years of age have free breast cancer screening
45 to 69
__ women on average will be detected breast cancer everyday
7
prognosis - women who were diagnosed w breast cancer younger than 40 has ______ prognosis
poorer
around ____% of breast cancer occurs in women who are over ____, 8% in ___s
75, 50, 40
For women aged___ - ___years, the risk of death from breast cancer is reduced by about a fifth
45–49
Risk factors: Breast cancer
Age (as women gets older) Genetic factors (genes like BRCA1 and BRCA2 ) Gender (100 times more common in women) Family history Race (slightly more in white women) Dense breast tissue
Signs & symptoms: Breast cancer
- A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle
- A change in the size, shape, or contour of the breast
- A change in the feel or appearance of the skin on the breast or nipple
For DCIS (Ductal carcinoma in situ), chemotherapy is not recommended, but ________ may be recommended for tumors which contain an abundance of estrogen receptors.
tamoxifen,
Stage 0 Breast Cancer
This is noninvasive breast cancer, or DCIS. Cancer cells are limited to the lining of the ducts and have not spread beyond the duct.
Stage I (IA/B) Breast Cancer
The cancer has spread from the ducts or lobules into the nearby fatty tissue of the breast. The tumor diameter is between 2 and 5 centimeters
Stage III (IIIA/B) Breast Cancer
The tumor may be larger than 5 centimeters and the cancer may or may not have spread to the nodes, or the tumor is smaller with several nodes involved. Stopping the spread of the cancer is a major concern. A diagnosis of inflammatory breast cancer is classified as stage III breast cancer.
Stage IV/Metastatic Breast Cancer
The cancer has spread from the breast and lymph nodes to other parts of the body; there are usually organs involved, including the lungs, liver, bones and/or brain.
Lumpectomy and partial mastectomy
are breast-conserving operations in which the surgeon removes the tumor together with some normal breast tissue surrounding it. Breast-conserving procedures can often be done with local anesthesia and sedation or under general anesthesia
Total (Simple) mastectomy
The surgeon removes the entire breast, but not the lymph node nor the muscles beneath the breast
likely drips and drains in situ: Breast cancer
- drain at surgical site (blood and fluid)
- IV
- PCA
- CVP
pre operative interventions/education: Breast cancer
-Education: about the surgical procedure; post operative care including follow up; affect of surgery
the long term ( post discharge) complications following mastectomy that Px may need to be aware of?
- psychological change
- altered sensation
- recurrence of tumour / cancer - live in fear
- depression
Breast reconstruction may be offered at the time of surgery (one-stage) or following surgery (two-stage: the type most often done if implants are used). what are the breast reconstruction options?
- TRAM (transverse rectus abdominis muscle) flap: uses tissue and muscle; can decrease the strength in your belly; results in a tightening of the lower belly, or a “tummy tuck.”
- DIEP (deep inferior epigastric artery perforator) flap: uses fat and skin from the same area as in the TRAM flap but does not use the muscle to form the breast mound. The procedure takes longer than the TRAM, but leaves less muscle weakness and causes fewer hernias.
Hormonal therapy: Breast cancer
Tamoxifin: blocks the actions of estrogen and is used to treat and prevent some types of breast cancer.
Adjuvant therapy: Breast cancer
cancer chemotherapy employed after the primary tumor has been removed, which helps avoid recurrence
Side effects: Adjuvant therapy
more likely to get infection, bruise or bleed easily,fatigue easily, hair loss, loss of appetite, nausea, vomiting, diarrhoea, or mouth sore.
Neoadjavant: Breast cancer
Treatment of the tumor with drugs before surgery to reduce the size of the tumor
