Upper GI Cancers Flashcards
Oesophageal Cancer:
What is the most common type of cancer that occurs in the lower third?
What is the most common type of cancer that occurs in any part of the oesophagus?
Adenocarcinoma
Squamous cell carcinoma
Oesophageal Cancer - Risk factors:
Lifestyle and demographic:
- What sex is it more likely in?
- Other lifestyle factors - 3
What 2 diseases may cause intestinal metaplasia?
2 risk factors that also cause dysphagia?
What GI infection may actually reduce the risk?
Male Obesity Alcohol High-fat diet ----- GORD Barrett's oesophagus
Achalasia and strictures
H.pylori
Oesophageal Cancer - S+S:
2 main symptoms
Where may you also have pain?
What other cancer sign do they usually have?
What symptom could they have if the cancer is in the upper third and why?
Why might cancer in the upper third cause aspiration pneumonia?
Dysphagia and odynophagia - difficulty with solids first then liquids
Retrosternal
Weight loss
Hoarse voice (compression of the recurrent laryngeal nerve)
Coughing during eating
Oesophageal Cancer:
Why do FBC?
How is a diagnosis made? - 2
What scans can be used to decide what stage it’s at? - 2
What scan can be used to look for metastases?
Show microcytic anaemia
Endoscopy and biopsy
CT and endoscopic USS
A PET scan
Oesophageal Cancer - Curative treatment:
What percentage of resectable?
How can they be resected? - 2
When is chemotherapy done, neoadjuvant or adjuvant?
What can be done to the oesophagus if some of it is resected to maintain its function?
How can localised squamous cell carcinoma be treated?
33% - 1/3
Open or laparoscopic oesophagectomy plus lymphadenectomy
Neoadjuvant
Anastamose remaining segment to stomach
Chemoradiation
Oesophageal Cancer - Palliative care for irresectable tumour:
What can be done to relieve dysphagia? - 2
Why is finding this cancer early important?
Dilatation, stenting or laser treatment
Chemotherapy
It has a very low survival rate
Gastric Cancer:
What type of cancer makeup 90% of these?
Risk factors:
- GI infection
- Demographics - 2
- What food can also increase your chance of stomach cancer?
- Lifestyle - 1
Adenocarcinomas
H.pylori
Elderly and male
Pickles - due to high amount of nitrates and salts
Smoking
Gastric Cancer - S+S - Non-specific:
Symptoms:
- Main one
- Late signs - 2
- Other non-specific symptoms - 3
- How else may it present more acutely?
- What may tiredness and SOB suggest?
Weight loss
Epigastric pain
Dyspepsia
N&V
Anorexia
Dysphagia
Upper GI bleed
Perforation
Anaemia
Gastric Cancer - S+S - Non-specific:
Signs:
- Where would you feel a mass?
- What may happen to the liver and the consequences of that?
- Where may lymph nodes be felt?
- What is a rare dermatological sign of stomach cancer?
Epigastric
Hepatomegaly - leads to jaundice and/or ascities
Virchow’s node
Acanthosis nigricans - look at pics
Gastric Cancer - Investigations:
Why do you do FBC and LFTs?
What is needed to make a definite diagnosis?
What scans can be used to decide what stage it’s at? - 2
What scan can be used to look for metastases?
Anaemia and mets
Gastroscopy and biopsy
CT CAP and staging laparoscopy
PET
Gastric Cancer - Management:
Curative surgery that can be done?
Palliative surgery that can be done?
Gastroectomy - total if proximal and subtotal if antral + lymphadenopathy
Subtotal gastroectomy especially for obstructing tumours
Gastric Cancer - Management:
What is done perioperatively (pre and post-op) if it is localised and if it is advanced?
What can be put in place to relieve a pyloric obstruction?
Chemo
Adjuvant chemoradiation
Endoscopic pyloric stent
Gastric Cancer - Complications:
Why may the stomach eventually not be able to expand properly?
Where may it spread to?
This cancer may spread through the stomach wall causing linitis plastica (aka leather bottle stomach)
Pancreas Liver Spleen Lymphatic Lungs - via blood
Pancreatic Cancer:
2 types of pancreatic cancer?
Why is it important to know there are 2 types?
Exocrine - produce enzymes that help with digestion (e.g. lipase)
Endocrine - produce hormones that are secreted in the blood (e.g. insulin)
Knowing the type of tumour is important because each type acts differently and responds to different treatments.
Exocrine pancreatic cancer:
What type of cancer is it usually?
Where is it usually found?
Where are periampullary tumours found? Why do they have a better prognosis?
Ductal adenocarcinoma - present late, mets early
Head of the pancreas - the rest are in tail or body
Within 2 cm of the ampulla of Vater in the duodenum
They cause earlier biliary obstruction and hence earlier presentation
