Upper GI Cancer

Question 1

How would you differentiate between achalasia and a more insidious pathology (malignancy)?

Answer 1

Achalasia - paralysis of myenteric plexus = mutual disruption of solids & liquids, sudden onset anorexia; sudden UWL

Obstruction (malignancy) - progressive dysphagia (solid then liquid)) = gradual UWL

Question 2

Which neoplasia is most commonly associated with Barrett’s oesophagus?

Answer 2

Oesophageal adenocarcinoma
(50 times risk)

Question 3

What is the most common type of oesophageal carcinoma?

Answer 3

Oesophageal adenocarcinoma

Question 4

What is the difference between adenocarcinoma and squamous cell carcinoma of the oesophagus on a hx?

Answer 4

AC - associated with GORD and Barrett’s oesophagus

SCC - associated with smoking and alcohol hx

Question 5

What are carcinoid tumours?

Answer 5

Rare, slow-growing malignancies of the neuroendocrine system.
- 5-10% functional (Serotonin-secreting)

Question 6

Where are carcinoid tumours typically found?

Answer 6

• appendix
• small intestine

Question 7

How do carcinoid tumours classically present?

Answer 7

• abdo pain
• diarrhoea
• flushing
• wheeze
• pulmonary stenosis

(Effect of breakdown products of serotonin on systemic circulation - ONLY if liver mets as products can drain straight to hepatic vein)

Question 8

How are carcinoid tumours managed?

Answer 8

Octreotide
(Or surgical resection)