Tumours of the Oesophagus and stomach

Question 1

What is a preventing symptom of oesophageal gastric cancer

Answer 1

Haematemesis - fresh bright blood vomited up - been in GI system less than 24 hours
Melena -dark blood been process through the GI system

Question 2

What is haematochezia

Answer 2

Passage of fresh blood through anus often with stool

Question 3

What blood tests can determine whether blood is from upper or lower GI

Answer 3

Urea
raised urea alone - upper GI bleed
Not completely reliable
Won’t be raised if liver damage

Question 4

What would you present with if you had an obstructing cancer at the pylorus

Answer 4

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

Question 5

What is Boerhaave

Answer 5

spontaneous rupture of oesophagus

Question 6

What can be used to identify where vomit has come from

Answer 6

Presence of bile

Question 7

The outcome of gastric cancer is usually good, true/false

Answer 7

False

very bad

Question 8

Pathway of oesophagus

Answer 8

left-right

lil bit back to the left

Question 9

What is a transthroracic oesophagectomy

Answer 9

Attach stomach to abdominal wall

Rubber tube connects oesophagus to stomach

Question 10

Outcome of oesophageal cancer is much better than gastric cancer true/false

Answer 10

True

Question 11

What is the treatment for oesophageal cancer

Answer 11

Laparoscopic Oesophagectomy

Question 12

Sections of the oesophagus

Answer 12

Upper
Middle
Lower

Question 13

What is cancer

Answer 13

Unregulated growth of cells due to loss of regulatory mechanisms such as P53 (tumour suppressor)

Question 14

What do cancer cells look like

Answer 14

Large dark nucleus
Abnormal number of chromosomes
cluster of cells without a boundary
Variations in size and shape of cells

Question 15

When is the peak incidence of oesophageal cancer age

Answer 15

70

Question 16

Peak incidence of gastric cancer age

Answer 16

80

Question 17

Why does cancer incidence increase with age

Answer 17

Every time cells divide a tiny bit of telomerase is lost

As you age more telomerase is lost increasing cancer risk

Question 18

What is telomerase

Answer 18

Protective cap at the end of chromosomes preventing deterioration of the chromosome

Question 19

What are the linings of the oesophagus

Answer 19

mucosa - inner most lining = satisfied squamous epithelium
submucosa
muscular layer

Question 20

What happens to the mucosal cells when oesophagus meets the stomach

Answer 20

Changes to columnar epithelial

Question 21

What is the junction between the oesophagus and the stomach

Answer 21

Z line

squamo-columner junction

Question 22

Irritants of the oesophagus

Answer 22

Acid production - type of food
Alcohol
Smoking

Question 23

What are the most common oesophageal cancers in the east

Answer 23

Squamous cancers

Question 24

What are the most common oesophageal cancers in the west

Answer 24

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

Question 25

Common cause of reflux in west

Answer 25

Obesity

Alcohol

Question 26

Commonest cause of dysphagia

Answer 26

Oesophageal cancer closing off the lumen of the oesophagus
takes 4-6 months
progressive dysphagia

Question 27

What does PET scan show

Answer 27

Picks up glucose metabolism
Glucose is given to patient
Cancers use a lot of glucose so light up

Question 28

How do you treat dysphasia in palliative are

Answer 28

Insert stent to open oesophagus

Question 29

When is oesophageal cancer non-resectable

Answer 29

Local invasion to aorta

Metastasis

Question 30

How to treat non-resectable oesophageal cancer

Answer 30

Palliative care
stent for dysphagia
Maybe some chemo

Question 31

What oesophageal cancers are sensitive to radiotherapy

Answer 31

Squamous - YES

adenocarcinoma - NO - use chemo instead