Tumours of the Oesophagus and stomach Flashcards
What is a preventing symptom of oesophageal gastric cancer
Haematemesis - fresh bright blood vomited up - been in GI system less than 24 hours
Melena -dark blood been process through the GI system
What is haematochezia
Passage of fresh blood through anus often with stool
What blood tests can determine whether blood is from upper or lower GI
Urea
raised urea alone - upper GI bleed
Not completely reliable
Won’t be raised if liver damage
What would you present with if you had an obstructing cancer at the pylorus
Abdominal pain
Feeling of fullness - early satiety
Vomiting of food - recently eaten food with no bile in it, its coming from before bile enters GI tract
What is Boerhaave
spontaneous rupture of oesophagus
What can be used to identify where vomit has come from
Presence of bile
The outcome of gastric cancer is usually good, true/false
False
very bad
Pathway of oesophagus
left-right
lil bit back to the left
What is a transthroracic oesophagectomy
Attach stomach to abdominal wall
Rubber tube connects oesophagus to stomach
Outcome of oesophageal cancer is much better than gastric cancer true/false
True
What is the treatment for oesophageal cancer
Laparoscopic Oesophagectomy
Sections of the oesophagus
Upper
Middle
Lower
What is cancer
Unregulated growth of cells due to loss of regulatory mechanisms such as P53 (tumour suppressor)
What do cancer cells look like
Large dark nucleus
Abnormal number of chromosomes
cluster of cells without a boundary
Variations in size and shape of cells
When is the peak incidence of oesophageal cancer age
70
Peak incidence of gastric cancer age
80
Why does cancer incidence increase with age
Every time cells divide a tiny bit of telomerase is lost
As you age more telomerase is lost increasing cancer risk
What is telomerase
Protective cap at the end of chromosomes preventing deterioration of the chromosome
What are the linings of the oesophagus
mucosa - inner most lining = satisfied squamous epithelium
submucosa
muscular layer
What happens to the mucosal cells when oesophagus meets the stomach
Changes to columnar epithelial
What is the junction between the oesophagus and the stomach
Z line
squamo-columner junction
Irritants of the oesophagus
Acid production - type of food
Alcohol
Smoking
What are the most common oesophageal cancers in the east
Squamous cancers
What are the most common oesophageal cancers in the west
Oesophagus is exposed to acid in the stomach
Squamous lining is eroded and replaced by columnar (barrets oesophagus)
Therefore - columnar cancer with is an ADENOCARCINOMA
Common cause of reflux in west
Obesity
Alcohol
Commonest cause of dysphagia
Oesophageal cancer closing off the lumen of the oesophagus
takes 4-6 months
progressive dysphagia
What does PET scan show
Picks up glucose metabolism
Glucose is given to patient
Cancers use a lot of glucose so light up
How do you treat dysphasia in palliative are
Insert stent to open oesophagus
When is oesophageal cancer non-resectable
Local invasion to aorta
Metastasis
How to treat non-resectable oesophageal cancer
Palliative care
stent for dysphagia
Maybe some chemo
What oesophageal cancers are sensitive to radiotherapy
Squamous - YES
adenocarcinoma - NO - use chemo instead
