T12: Esophageal & Gastric Cancer Flashcards
esophageal cancer cause
unknown, Incidence ↑ with age, ↑ in non-Hispanic white men and Alaska Natives, and higher in men than in women
risk factors for esophageal cancer
o Barrett’s esophagus
o GERD (because of erosion of cells)
o Smoking
o Excessive alcohol intake
o Obesity
o History of achalasia (a condition in which there is delayed emptying of the lower esophagus, difficulty swallowing)
clinical manifestations of esophageal cancer
o Symptom onset is late
o Progressive dysphagia is most common symptom
- Initially with only meat, then with soft foods, and eventually with liquids
o Odynophagia: burning, squeezing pain while swallowing
o Pain, choking, heartburn, hoarseness, cough, anorexia, weight loss, regurgitation
If tumor is in upper third of esophagus s/s
o Sore throat
o Choking
o Hoarseness (may be pressing on larynx)
o Esophageal Cancer
diagnostics for esophageal cancer
o Endoscopy with biopsy (necessary for definitive diagnosis)
o Endoscopic ultrasonography (EUS) (important tool to stage)
o Esophagogram (barium swallow)
o Bronchoscopic examination (detects involvement of lung)
o CT & MRI
o CEA: blood test that is a cancer marker
o CBC, platelets
CEA
blood test that is a cancer marker
treatment for esophageal cancer
o Best results with multimodal therapy (depends on the staging of the cancer)
-CHEMO AND CORTICOSTEROIDS TO DECREASE INFLAMMATION, PPI AND H2 BLOCKERS TO DECREASE GASTRIC ACID
Esophagectomy
removal of part or all of esophagus
after esophagectomy: nutrition
· Need feeding tube or enteral nutrition (pure liquid formula)
o Care for feeding tube: check gastric residuals
o Oral care, FLUSH TUBE AFTER ANY MEDICATION
gold standard for tube placement
x-ray
Esophagogastrostomy
resection of portion of esophagus and anastomosis of remaining portion to stomach
Photodynamic therapy
· Inject IV porfimer (Photofrin), which is absorbed by cancer tissue
· Light transmitted through an endoscopic fiber reacts with porfimer, starting a reaction that destroys cancer cells
what is important after photodynamic therapy
Must avoid direct sunlight 4 weeks after
Endoscopic mucosal resection (EMR): for stage 1
· Removes superficial lesions or submucosal neoplasms
· Radiofrequency ablation used to kill cancer cells
· Option for some small, very early stage cancers
Dilation
increases (dilates) lumen of esophagus