Tumours of Oesophagus and Stomach

Question 1

what blood test can determine whether blood is from upper or lower GI tract?

Answer 1

Urea

raised urea alone = upper GI bleed

Question 2

how reliable is raised urea in conforming upper GI bleed?

Answer 2

not completely

wont be raised if liver damage

Question 3

obstructing cancer at the pylorus presentation?

Answer 3

upper abdo pain
feeling of fullness
vomiting undigested food from past few days, wont contain bile

Question 4

what is a baurhaus?

Answer 4

spontaneous rupture of the oesophagus

Question 5

what does the presence of bile in vomit indicate?

Answer 5

the position of the obstruction
no bile = before ampulla of vater
bile = after

Question 6

what is the outcome of gastric cancer?

Answer 6

very bad

Question 7

what is a transthoracic oesophagectomy?

Answer 7

Take oesophagus out

Connect rubber tube from upper end of remaining oesophagus and connect it to the stomach from outside the body

Question 8

which has a better outcome, oesophagus or gastric cancer?

Answer 8

oesophagus

Question 9

what is the treatment for oesophageal cancer?

Answer 9

oesophagectomy - often laproscopic

Question 10

what is cancer?

Answer 10

unregulated growth of cells due to:

- loss of mechanisms like P53

Question 11

name some differences between normal and cancerous cells

Answer 11

cells continue to grow and divide
variations of shape and size
nucleus larger and darker
abnormal number of chromosomes in disorganised fashion
cluster of cells without a boundary

Question 12

what is the peak incidence of oesophageal and gastric cancer?

Answer 12

oesophageal = 70
gastric = 80

Question 13

what happens to cells as we age?

Answer 13

telomeres are like tips on the end of shoelaces to protect ends of DNA
telomeres shorten as we age making the DNA/genes vulnerable to damage

Question 14

what is the lining of the oesophagus?

Answer 14

mucosa
submucosa
muscularis

Question 15

what type of epithelium in the oesophagus?

Answer 15

stratified squamous (pale pink)
follows on from mouth, pharynx etc

Question 16

what type of epithelium in stomach?

Answer 16

columnar (darker red/pink)

Question 17

what is the dividing line between oesophageal and stomach epithelium?

Answer 17

squamo-columnar junction
or
Z line
(where pale pink becomes darker pink/red)

Question 18

what type of cancer will occur most commonly in the oesophagus?

Answer 18

squamous in the East (usually due to injury)

Adenocarcinoma from Barret’s oesophagus in the west (usually due to reflux)

Question 19

what can irritate the oesophagus?

Answer 19

alcohol
smoking
food
Acid from stomach

Question 20

what is the most common cause of acid reflux?

Answer 20

obesity

Question 21

where do cancers of the oesophagus usually occur in the west?

Answer 21

bottom of oesophagus

Question 22

what is the most common cause of dysphagia?

Answer 22

stroke

Question 23

what is the time frame for development of oesophageal cancer?

Answer 23

5-6 months

Question 24

what is the red flag for oesophageal cancer?

Answer 24

progressive dysphagia

weight loss

Question 25

what is the first investigation for suspected oesophageal cancer?

Answer 25

endoscopy
as cancers arise from the lining
Biopsy the tumour

Question 26

what do you give someone before a PET scan?

Answer 26

radio glucose

Question 27

when is an oesophageal cancer not resectable?

Answer 27

local invasion to the aorta

metasteses

Question 28

what is palliative care for oesophageal cancer?

Answer 28

stent to help dysphagia

palliative chemo/radiotherapy

Question 29

which has better outcome, direct surgery or combined modality?

Answer 29

combined modality (chemo/radiotherapy + surgery)

Question 30

what is the structure of treatment for both oesophageal and gastric cancer?

Answer 30

chemo > surgery > chemo

Question 31

which type of cancer is more sensitive to radiotherapy?

Answer 31

squamous

adenocarcinoma not really sensitive to radiotherapy