Oesophogogastric malignancy

Question 1

Risk factor of gastric cancer?

Answer 1

-Helicobacer pylori
triggers inflammation of the mucosa →atrophy and intestinal metaplasia
-atrophic gastritis
-diet
salt and salt-preserved foods
nitrates
-smoking
-blood group

Question 2

Features of gastric cancer?

Answer 2

-abdominal pain
typically vague, epigastric pain
may present as dyspepsia

-weight loss and anorexia
-nausea and vomiting
-dysphagia: particularly if the cancer arises in the proximal stomach
-overt upper gastrointestinal bleeding is seen only in a minority of patients
-if lymphatic spread:
left supraclavicular lymph node (Virchow’s node)
periumbilical nodule (Sister Mary Joseph’s node)

Question 3

Investigations of gastric cancer?

Answer 3

-diagnosis: oesophago-gastro-duodenoscopy with biopsy
signet ring cells may be seen in gastric cancer. They contain a large vacuole of mucin which displaces the nucleus to one side. Higher numbers of signet ring cells are associated with a worse prognosis

-staging: CT

Question 4

Management of gastric cancer?

Answer 4

-surgical options depend on the extent and side but include:
endoscopic mucosal resection
partial gastrectomy
total gastrectomy

-chemotherapy

Question 5

What causes oesophageal cancer?

Answer 5

Adenocarcinoma is now the most common type of oesophageal cancer and is more likely to develop in patients with a history of gastro-oesophageal reflux disease (GORD) or Barrett’s.

The majority of adenocarcinomas are located near the gastroesophageal junction whereas squamous cell tumours are most commonly found in the upper two-thirds of the oesophagus.

Question 6

Symptoms of oesophageal cancer?

Answer 6

dysphagia: the most common presenting symptom
anorexia and weight loss
vomiting
other possible features include: odynophagia, hoarseness, melaena, cough

Question 7

Diagnosis of oesophageal?

Answer 7

-Upper GI endoscopy with biopsy is used for diagnosis
-Endoscopic ultrasound is the preferred method for locoregional staging
-CT scanning of the chest, abdomen and pelvis is used for initial staging
-FDG-PET CT may be used for detecting occult metastases if metastases are not seen on the initial staging CT scans.
-Laparoscopy is sometimes performed to detect occult peritoneal disease

Question 8

Treatment of oesophageal cancer?

Answer 8

-Operable disease is best managed by surgical resection - the most common procedure is an Ivor-Lewis type oesophagectomy
-The biggest surgical challenge is that of anastomotic leak, with an intrathoracic anastomosis resulting in mediastinitis
-In addition to surgical resection many patients will be treated with adjuvant chemotherapy