Upper GI cancer Flashcards
Some of associations of gastric Ca
Pernicous anaemia
Blood group A
H pylori
Nitrosamine exposure
Borrman classification of gastic tumours
i) Polypoid
ii) Ex-cavating
iii) Ulcerating and raised
iv) Diffusely infiltrative
Troiser’s sign
Virchow’s node (left supraclavicular)
Kruckenberg tumour
gastric tumour spread to ovaries via transcoelomic route
Stage of presentation of most gastric tumours
Mostly present late at locally advanced (inoperable) or mets
Main ix for gastric Ca
Gastroscopy and multiple ulcer edge biopsies
How to stage gastric Ca
Endoscopic USS helps identifying thickness
CT/MRI
Laproscopic staging (for locally advanced)
Peritoneal washings use for gastric ca
cytology helps identify peritoneal mets
Rx of gastic cancer
Partial gastrectomy (distal disease) or full (proximal)
+ Chemo (epirubicin, cisplatin and 5-fluorouracil)
Endoscopic mucosal resection (for early disease)
Targeted rx
Targeted rx for gastric Ca
trastuzumab for HER2 + tumours
Oesophageal ca RFs
Obesity/alcohol/smoking
Achalasia
Low vit A&C intake
Nitrosamine exposure
Reflux oesphagitis +/- Barrett’s
Achalasia
failure of relaxation of smooth muscle
lower oesophageal spincter contracts
Sites and types of oesophageal ca
20% upper (SCC)
50% middle
30 % lower (adenocarcinoma)
Sx of oesophageal ca
dysphagia
wt loss
retrosternal chest pain
Sx specific to upper 3rd oesophageal ca
Hoarseness
Cough
Ix for oesophageal ca
Oesophageoscopy + biopsy +/- EUS (gold standard)
MRI/CT
Laproscopic if sig infradiaphragmatic spread
Rx of oesophageal ca
If T1/2 pre-op chemo + radical oesophagectomy
Others Ts: Chemo/radio/stenting/laser for palliation
Gall bladder/bile duct cancer cell type
adenocarcinoma
RF for gallblader/bile duct ca
primary sclerosing cholangitis
Rx of gallbladder/bile duct ca
Very poor prognosis
Radical surgery (rarely effective)
Palliative stenting/chemo
Commonest liver tumour
Mets 90%
Cancer mets to liver?
Breast
Bronchus
GI
Hepatocellular carcinoma causes
HBV, HCV, cirrohsis
aflatoxin (from mold in soil)
Clonorchis sinensis (parasite)
anabolic steroids
Rx of HCC
if<3cm, resect
Percutaneous ablation
Transplant
Sorefenib
