Upper and lower GI cancers Flashcards
What type of mucosal lining is found in the oesophagus?
Squamous cell mucosal lining
What type of mucosal lining is found in the stomach?
columnar epithelial lining
Where are most of the tumours of the oesophagus found?
Oesophago-gastric junction
What are adenocarcinomas and where in the oesophagus are they usually found?
They are malignant tumours which develop due to dysplasia of glandular and columnar epithelium at the distal end of the oesophagus.
What are some risk factors for squamous cell carcinoma?
Smoking
Alcohol
Diet
Achalasia (nerve damage to the myenteric plexus which causes the LOS to stay tensed)
Leukoplakia (white patches on mucosal surfaces)
Adenocarcinoma risk factors?
Obesity - increased risk of GORD
GORD
Smoking
Alcohol
Barretts oesophagus (metaplasia of squamous cell epithelium to columnar epithelium which migrates upwards from gastro-oesophageal junction.)
What is barretts oesophagus and what is its correlation with oesophageal cancer?
Metaplasia of squamous cell epithelium to columnar cell epithelium which migrates upwards from the gastro-oesophageal junction.
Following from metaplasia there can by dysplasia which can result in an invasive carcinoma. (breaches basement membranes)
1-5% of ppl w/ barretts will develop oesophageal cancer.
What are some signs and symptoms of oesophageal cancer?
Dysphasia Indigestion or heartburn Chest pain Vomiting/regurgitation of food Melena (blood in stool) Haematemesis (vomiting blood) Weight loss
How can we diagnose oesophageal cancer?
Medical history - dysphagia, weight loss, melena, haematemesis.
Examination of abdomen
Special investigations:
1st - endoscopy and biopsy
2nd - staging investigations
What is an endoscopy?
What is an OGD?
Is the primary step in investigations for oesophageal cancer.
Allows direct visualisation and access for biopsy for tumours
Oesophago-gastro-duodenoscopy
What are some methods of investigation in order to stage oesophageal cancers?
CT
Endoluminal ultrasound
Laparoscopy (examination of inside of abdominal cavity to check for spread of cancer outside oesophagus)
What is the TNM method for staging cancers?
T - tumour size and depth?
N - malignant lymph nodes?
M - metastatic disease?
What is radical treatment?
Treatment with intent to cure the pt
What are some radical treatment options for oesophageal cancer?
Oesophagectomy alone
Pre-op chemo
Surgery, chemo, radio
Chemoradiotherapy
What are the outcomes after oesophagectomy?
Mortality - 5-10% short term
Morbidity - 25%
Median survival - 13.5 months
How an we palliatively treat pts suffering from terminal oesophageal cancer who have dysphagia?
Endoscopic stent placement - keep oesophagus open
Tumour destruction
Palliative radiotherapy
Palliative chemotherapy
What is the epidemiology of gastric cancer?
mainly males
>65 yrs old
poor socio-economic status
high incidence in far east
What are some risk factors for gastric cancer?
Gastritis
Pernicious anaemia - deficiency in vitamin B12
Previous gastric surgery
Dietary factors (e.g. low fresh fruit)
Smoking
Blood group A
Family history
What are some signs and symptoms of gastric cancers?
Dysphagia persistent acid indigestion or heartburn (dyspepsia) Chest pain Vomiting/regurgitation of food Melaena Haematemesis Weight loss Feeling of persistent fullness after eating
How can we diagnose gastric cancer?
History Examination Investigations - endoscopy and biopsy - staging CT, ultrasound, laproscopy
What are some radical treatments for gastric cancer?
Total gastrectomy
Subtotal gastrectomy
What are the outcomes of gastrectomy?
Mortality - 5%
Morbidity - 25%
5 yr survival - 10%
What are some risk factors of colorectal cancer?
Age
Genetics and family history
Crohn’s and ulcerative colitis
Diet and lifestyle factors (red meat)
Obesity
smoking
Alcohol
What is familial adenomatous polyposis?
It is a condition which is passed down through families
Causes the formation of lots of polyps in colon
These polyps may turn into cancer - so patients with familial adenomatous polyposis are screened often.
What is gardner’s syndrome?
Subtype of familial adenomatous polyposis.
- pts may form osteomas (benign tumours of bone)
- if seen must refer pt for further colonoscopic investigations
What are some symptoms of colorectal cancer?
Melena
Change in normal bowel habit
Palpable lump
Tenesmus - feeling of incomplete rectal emptying
Weight loss
Pain
How can we diagnose colorectal cancer?
Colonoscopy
Ct colonography
BARIUM ENEMA
How can we stage colorectal cancer?
CT chest/abdomen/pelvis (to check spread to distal organs)
MRI rectum (rectal cancer only)
What are the two classifications we an use to stage colorectal cancer?
TMN (size & depth, lymph, metastasis)
Duke’s staging
Staging depends on depth of bowel wall invasion, lymph node involvement and distant organ metastases.
What are some radical treatments of colorectal cancer?
Pre-op chemotherapy
Resection (colonectomy)
Post op chemotherapy
Liver/lung resection
What is some palliative care for colorectal cancer?
Stent
Palliative resection
Chemotherapy - in order to extend period of life.
What ages are people in the UK screened for bowel cancer? How are they screened and what is the point of screening?
They are screened d60-74 yrs old
They are screened using home testing kit which looks at faecal occult blood.
Aim = detect disease in early stage.
Stage 1 = 95% 5 yr mortality
Stage 4 = 5% 5 yr mortality
