Upper GI Malignancy Flashcards
List 3 key symptoms associated with Upper GI Malignancy
- Epigastric pain
- Jaundice
- Dysphagia
What are 3 types of obstruction leading to Dysphagia?
- Extraluminal (compression from outside)
- Intraluminal (in lumen)
- Luminal (in wall)
List the Red Flags of Dysphagia
ALARM
- Anaemia
- Loss of Weight
- Anorexia
- Recent onset of progressive symptoms
- Masses/ Malaena
List 3 Benign causes of Dysphagia
- Fibrous strictures
- Foreign bodies
- Nervous disorders
List 2 Malignant causes of Dysphagia
Oesophageal Carcinoma;
- Squamous cell carcinomas (Strat Squamous epithelia)
- Adenocarcinomas (Columnar epithelia)
Which Oesophgeal Carcinoma is more common
- Oesophageal Carcinoma (as mostly Strat squamous)
- Lower 1/3 can develop Adenocarcinoma (Barret’s oesophagus)
What are 2 risk factors for Oesophageal carcinoma?
How does it present?
- Smoking
- Barret’s Oesophagus
- Progressive Dysphagia (Solids-> Liquids)
- Spread is common if presenting with symptoms
What are 2 methods if investigating for Oesophageal carcinoma?
How good is the prognosis?
- Endoscopy
- Barium swallow
Poor prognosis (5% survival at 5 years)
List 4 BENIGN conditions that can cause Epigastric pain
- Oesophagitis
- Gastritis
- Peptic Ulcer Disease PUD
- Pancreatitis
What are 2 Red Flags for Epigastric Pain?
- Malaena
- Haematemesis
List 3 non-malignant causes of Haematemesis
- Ulcers
- Varices
- ‘Mallory-Weiss Syndrome’ (Repeated vomiting-> Oesophgeal tears)
Suggest 1 malignant cause of Haematemesis with Epigastric pain
Gastric Cancer
Describe Gastric Cancer in 4 ways
- Typically in Cardia or Antrum (Can cause Dysphagia and outflow obstruction)
- Typically Adenocarcinomas
- 50% have a palpable mass
- Pain similar to Peptic Ulcer (Epigastric)
List 6 risk factors of Gastric Cancer
- Age
- More common in Males
- Smoking
- High salt diet
- Family history
- H. pylori (Chronic inflammation anywhere can-> cancer)
Describe the Prognosis for Gastric Cancer
- 10% survival after 5 years
- 50% survival after surgery (removing part of stomach + reconstructive surgery
Name 2 types of Gastric Cancer other than Adenocarcinomas (most common)
- Gastric Lymphoma
- Gastrointestinal Stromal tumours (GISTs)
Describe Gastric Lymphoma
- In MALT tissue
- Presents similarly to Gastric Carcinoma
- Mostly associated with H. pylori
- Prognosis much better than Gastric Carcinoma
Describe GISTs
- Sarcomas
- Usually asymptomatic
- Typically Benign, can be Malignant
- Tend to be incidental findings on Endoscopy
List the Red Flags for Jaundice
- Hepatomegaly (especially with an irregular border)
- Weight loss
- Ascites
- Painless
Describe Primary Malignancy of the Liver
- Very rare
- Hepatocellular Carcinomas
- Typically linked to underlying disease (chronic inflammation)
- Common site for metastases (Any malignant cells in body enter liver)
What are 3 routes via which malignancies can metastasise to the liver
- Haematogenous (portal circulation)
- Via lymphatics (common in carcinomas)
- Transcoelomic spread (through body cavities, e.g ovarian, breast lung)
What percentage of Pancreatic Cancers are exocrine?
What’s the most common Pancreatic Cancer?
80-90%
Ductal Adenocarcinomas
(Neuroendocrine cancers are rare, and produce insulin)
Compare the presentation of Pancreatic Cancers originating in the Head and Body/Tail
Head: Jaundice
Body/ Tail: Symptoms more vague (Malabsorption, Steatorrhea)
List 5 risk factors for Pancreatic Cancer
- Family history
- Smoking
- Age (>60)
- More common in males
- Chronic Pancreatitis
Describe the Prognosis of Pancreatic Cancer
Extremely poor, survival often measured in months rather than years
