Oesophagus and Stomach 1 and 2 - Oesophageal and Gastric Tumours, Oesophageal Conditions Flashcards

1
Q

What are the 2 possible types of oesophageal cancer?What is the most common?Where is each more likely to occur?what are the main things that increase the incidence of each type?

A

Adenocarcinoma (distal oesophagus) - more common - GORDSquamous cell carcinoma (proximal oesophagus) - smoking and drinking

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2
Q

signs and symptoms of oesophageal cancer? (8)

A

dysphagia:where the patient feels food sticking isn’t necessarily where the tumour isodynophagiaupper GI haemorrhageanaemiaweight lossretrosternal painif upper tumour, cough and hoarseness

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3
Q

What should be performed if you suspect oesophageal cancer? e.g. presence of dysphagia

A

An urgent upper GI endoscopyAlso perform a colonoscopy if the patent presents with anaemia

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4
Q

What 3 things should be done to help choose treatment for oesophageal and gastric cancers?

A

Determine treatment intentAssess patient fitnessAccurate staging

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5
Q

What is performed to accurately stage an oesophageal cancer?

A

CT thorax/ abdomen - if normal perform tests belowCT/PET, EUS, Laparoscopy (can spread intra-abdominally causing little seedlings in the abdomen - laparoscopy searches for this)search hard for metastatic diseaseif metastases present = palliative care

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6
Q

Palliative treatment options for oesophageal cancer? (3)

A

ChemotherapyRadiotherapyStenting - not very pleasant to swallow with

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7
Q

Treatment options for oesophageal cancer that can be potentially cured?

A

Surgery with or without NAC - offers better cure rates for early diseaseRadical chemoradiotherapy - complications are more manageable

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8
Q

What are the adverse prognostic factors for oesophageal cancer? (3)

A

Oesophageal obstructionTumour longer than 5cmMetastatic disease

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9
Q

Staging of oesophageal cancer using TNM?

A

Tis = carcinoma in situT1 = invading lamina propria/ submucosaT2 = invading muscularis propriaT3 = Invading adventitiaT4 = invasion of adjacent structuresNx = nodes cannot be assessedNO = no node spreadN1 = regional node metastasise M0 = no distant spreadM1 = distant metastasis

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10
Q

What types of gastric cancers do you get? (5)What is the most common type?

A

Adenocarcinoma - commonest typeRarer:lymphoma - better prognosisGastrointestinal Stomal Tumours - rarely metastasise = better prognosisSquamous cell carcinoma Neuroendocrine tumours

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11
Q

Signs and symptoms of gastric cancer? (10)

A

DysepsiaUpper GI bleedingAnaemiaweight lossAbdominal massAnorexia/ early satietyvomitingHepatomegalyjaundiceascites

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12
Q

How do you accurately stage a gastric cancer?

A

CT thorax/ abdomenLaparoscopy/ EUS

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13
Q

Palliative treatment for gastric cancer? (3)

A

ChemotherapyRadiotherapySurgical palliation e.g. for obstruction(Trastuzamab for Her-2 positive tumours)

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14
Q

Treatment for potentially curable gastric cancer?

A

surgery with or without NACsurgery based treatment is the only potentially curative option radiotherapy is not a treatment option for gastric cancers as the stomach is too big an organ and therefore you would poison the patient with radiotherapy

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15
Q

Adverse prognostic factors for gastric cancer (6)?

A

metastatic diseaseshort historyadvanced ageproximal lesions locally advanced lesionsuperficial gross appearance (limits plastica)

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16
Q

What is gastro-oesophageal reflux disease?

A

Reflux of stomach contents which causes troublesome symptoms and/or complications

17
Q

What causes GORD? (3)

A

Lower oesophageal sphincter doesnt work properlyIncrease in intra-abdominal pressureGastric acid hyper secretion

18
Q

What type of people have a higher chance of getting GORD? (4)

A

Pregnant peopleObese peopleSmokersIncreased association with alcohol

19
Q

Symptoms of GORD?

A

Heartburn (burning retrosternal discomfort after meals, lying, stooping or straining)belchingacid brash (acid/ bile regurgitation)Waterbrash (increased salivation)odynophagia (pain on swallowing e.g. from oesophagitis)nocturnal asthmachronic coughlaryngitissinusitis

20
Q

Complications of GORD?

A

OesophagitisUlcerationBenign strictureIron-deficiencyBarrett’s oesophagus = increased chance of oesophageal cancer

21
Q

What type of classification is used to classify GORD?

A

Los Angeles Classification

22
Q

Loss Angeles Classification?

A

“mucosal break” = a well-demarcated area of slough/ erythema) - used to encompass the old terms ulceration and erosion1 = more than or equal to 1 mucosal break, 5mm long but not extending beyond 2 mucosal fold tops3 = mucosal break continuous between the tops of 2 or more mucosal folds but which involves less than 75% of the oesophageal circumference4 = mucosal break involving greater than or equal to 75% of the oesophageal circumference

23
Q

Treatments fo GORD?

A

Physically repair the defective valve (surgery)H2 receptor antagonistsPPIsAnti-acids

24
Q

What causes achalasia?

A

Lower oesophageal sphincter fails to relx

25
Q

Symptoms of achalasia? (4)

A

DysphagiaregurgitationSubsternal crampsWeight loss

26
Q

Diagnosis of achalasia?

A

CXR (fluid level in dilated oesophagus)Barium swallow (dilated tapering oesophagus

27
Q

Treatment of achalasia?

A

endoscopic balloon dilation
Heller’s Cardiomyotomythen PPRI
Botulinum toxin injections (non-invasive - required every few months)
calcium channel blockers and nitrates also relax the sphincter
long standing achalasia may cause oesophageal cancer