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RT Yr 2 Sem 1 > Upper GI oncology > Flashcards

Upper GI oncology Flashcards

1
Q

What organs are contained in the upper GI? (4)

A
  • stomach
  • pancreas
  • liver
  • gallbladder
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2
Q

Where is the stomach located?

A
  • lies directly inferior to diaphragm

- connects oesophagus to duodenum

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3
Q

What is the function of the stomach? (2)

A
  • functions as mixing chamber and holding reservoir

- secretes a mixture of acid, mucus and digestive enzymes

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4
Q

What are the three parts of the stomach?

A
  • cardia (fundus)
  • body
  • pyloric antrum
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5
Q

What is the stomach’s blood supply?

A
  • branches of the coeliac axis
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6
Q

What are the stomachs regional lymphatics?

A
  • coiliec axis nodes
  • splenic hilar LNs
  • porta hepatatis LNs
  • gastroduodenal LNs
  • suprapancreatic LNs
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7
Q

What is the venous drainage of the stomach?

A
  • portal venous system into the liver
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8
Q

How do you differentiate a vein and artery in a CT image?

A
  • arteries are circular due to the high pressure

- veins are oval shaped

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9
Q

What is epidemiology?

A
  • study of population and spread of disease
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10
Q

What is aetiology?

A
  • study of causes of disease
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11
Q

What is the epidemiology of stomach cancer? (4)

A
  • 790 000 new cases annually worlwide
  • In AUS M:F = 1314:865
  • highest incidence rates 30-80/100 000 occur in far east, Russia, Eastern Europe and South America
  • Incidence rises steeply with age to over 200/100 000 men aged over 80 years
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12
Q

What is the Aetiology of stomach cancer?

A
  • diet
  • lifestyle
  • occupational
  • medical
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13
Q

What is the diet Aetiology of stomach cancer? (6)

A
  • low intake of animal fats and proteins
  • high intake of carbs
  • high salt intake
  • low intake of fruits and vegetables
  • diet rich in smoked food
  • diet high in nitrates
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14
Q

What is the lifestyle Aetiology of stomach cancer? (4)

A
  • poor nutrition
  • low socioeconomic status
  • alcohol
  • smoking
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15
Q

What is the occupational Aetiology of stomach cancer?

A
  • industrial dust exposure
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16
Q

What is the medical aetiology of stomach cancer? (3)

A
  • Genetic (Blood group A)
  • Pernicious anaemia due to B12 def (3-6x risk)
  • helicobacter pylori infection
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17
Q

What are the signs and symptoms of stomach cancer? (10)

A
  • vague epigastric discomfort
  • loss of appetite (weight loss)
  • nausea, vomiting
  • haematemesis
  • melena
  • occult bleeding
  • palpable epigastric mass
  • ascites
  • left supraclavicular adenopathy
  • jaundice
  • left axillary adenopathy
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18
Q

What percentage of cases of stomach cancer at presentation are metastatic?

A
  • 1/3
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19
Q

What is the local spread of stomach cancer?

A
  • many adjacent organs, omenta, pancreas

- regional lymph and blood channles in submucosa, subserosa

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20
Q

What is the chain of lymphatic spread of stomach cancer?

A
  • via superficial lymphatic network into nodes in left gastric chain and splenic and hepatic chain
  • then to nodes in coeliac plexus, splenic chain into hepatic chain around porta hepatis
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21
Q

Where is common blood born metastases for stomach cancer?

A
  • liver and lung
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22
Q

What is the pathology and percentages for stomach cancer?

A
  • adenocarcinoma (90-95%)
  • lymphoma (~5%)
  • carinoids
  • gastrointestinal stromal tumours
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23
Q

What is the clinical management for stomach cancer?

A
  • multi-disciplinary approach
  • surgery
  • neoadjuvant and adjuvant chemo
  • palliative chemotherapy
  • radiation
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24
Q

What should be in the CTV for stomach cancer?

A
  • gastric/tumour bed
  • gastric remnant
  • nodal stations along lesser and greater curvature of stomach
  • coeliac axis
  • suprapancreatic, porta hepatis and splenic groups
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25
Q

What are the OAR to be contoured for stomach cancer?

A
  • liver
  • kidneys
  • lung
  • heart
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26
Q

What is the common dose for adjuvant therapy of stomach cancer?

A
  • 45Gy in 25# with concomitant 5FU (5-fluoro-uracil) and leucovorin
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27
Q

What is the patient care for stomach cancer?

A
  • weekly full blood counts
  • dietetic assesment including weight
  • measures for gastrointestinal toxicity (nausea, diarrhoea)
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28
Q

What are the three parts of the pancreas and where are they located?

A
  • head at the c loop of duodenum
  • body is posterior to stomach and anterior the the IVC
  • tail terminated in splenic hilum
  • @ L1-L2
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29
Q

What are the organs surrounding the pancreas?

A
  • duodenum
  • jejunum
  • stomach
  • major vessels (IVC)
  • spleen
  • kidney
30
Q

What are the two main functions of the pancreas?

A
  • exocrine

- endocrine

31
Q

What is the exocrine function?

A
  • adding digestive juices and enzymes to partially digested food via small ducts
32
Q

What is the endocrine function?

A
  • produces hormones insulin which helps control the amount of sugar in blood stream
33
Q

What is the epidemiology of pancreatic cancer?

A
  • 790 000 new cases annually worldwide
  • in AUS M:F = 1408:1254
  • incidence increases with age
  • ubran and socioeconomically disadvantage populations higher incidence
34
Q

What are the main signs and symptoms of pancreatic cancer?

A
  • jaundice
  • abdominal pain
  • anorexia
  • weight loss
35
Q

What the the signs and symptoms of head/body pancreatic cancer?

A
  • obstructive jaundice
  • dark urine
  • cay coloured stool
  • abdominal pain
36
Q

What the the signs and symptoms of tail pancreatic cancer?

A
  • back pain

- weight loss

37
Q

What is the aetiology of pancreatic cancer?

A
  • smoking
  • occupation (rubber industry, benzidine dye industry)
  • medical (diabetes, chronic pancreatitis)
  • familial trend (first degree relative)
  • diet (high fat)
  • lifestyle
38
Q

What % of pancreatic patients present with locally advanced or metastatic cancer?

A
  • 80%
39
Q

What is the local spread of pancreatic cancer?

A
  • throughout pancreas
  • duodenum, stomach, colon
  • obstructs common bile duct
  • superior mesenteric artery
  • portal vein
  • celiac axis
40
Q

What is the pathology of pancreatic cancer?

A
  • adenocarcinoma (80%)
  • islet cell tumours
  • acinar cell carcinoma
  • cystadenocarcinomas
  • 50% diagnosed have distant mets
41
Q

What is % location of pancreatic cancer?

A
  • 60% in head
  • 25% in body and tail
  • 15% in tail alone
42
Q

What is the clinical management of pancreatic cancer?

A
  • primary resection which is only chance of cure
  • less then 20% are resectable
  • pancreaticoduodenectomy
  • chemo with possible radiation
43
Q

What is pancreaticoduodenectomy?

A
  • resection of head of pancreas and duodenum, distal stomach, gall bladder and common bile duct
  • has high local failure with 5% mortaility
44
Q

What are the palliative therapies for pancreatic cancer?

A
  • narcotics
  • coeliac plexus nerve blocks
  • biliary stenting
  • drainage of ascites
  • palliative chemo
  • palliative RT (bone/brain mets)
45
Q

What are the CTV margins for pancreatic cancer?

A
  • sup = cover coeliac axis (1.5-2cm)
  • inf = include superior mesenteric LNs
  • post = 1.5cm beyond ant margin vertebral body
  • ant = extend 1.5-2cm from GTV
46
Q

What is the dose for radical and palliative pancreatic treatment?

A

RADICAL:
- 45-50.4GY in 25-28# in combination with chemotherpy, 5FU

PALLIATIVE:
- 30Gy in 10#

47
Q

What are the acute side effects of pancreatic cancer?

A
  • nausea/diarrhoea

- serve mucositis or ulceration of stomach/duodenum

48
Q

What are the long term side effect of pancreatic cancer?

A
  • renal failure
49
Q

What region of the body is the liver located in?

A
  • right hypochondriac region

- superior level of liver buldges into the diaphragm at level T7-8

50
Q

What is the main role of the liver?

A
  • removing toxins from body
  • processing food nutrients
  • helping to regulate body metabolism
51
Q

What organs surround the liver?

A
  • stomach
  • pancreas
  • IVC
  • lung
52
Q

What is the epidemiology of liver cancer?

A
  • 5th most common in the world
  • strong association with chronic viral hepatitis, esp. Hep B
  • chronic liver infection
  • ageing population
  • increasing obesity
  • 3 to 4 times more common in men
53
Q

How much more likely are indigenous Australians more likely to develop and die from liver cancer?

A
  • 3x more likely to develop

- 3.3x more likely to die

54
Q

What are the presenting features of liver cancer?

A
  • abdominal pain
  • weight loss
    OR if hepatic mass is present
  • hepatic failure
  • ascites
  • alpha-fetoprotein is elevated in 50-70% of these patients
55
Q

What is the classification of primary hepatic tumours?

A
  • unifocal expansive
  • infiltrating
  • multifocal (50%)
56
Q

Where do hepatic tumours usually spread to?

A
  • invade portal vein and hence spread to the lung
57
Q

What is the management of hepatic cancer?

A
  • surgical resection is the only hope for long-term survival (only possible in <20% cases)
  • hepatectomy and transplantation
  • doxorubibin (chemo) with 10-20% response rate
  • Radiation but not used due to radiation hepatitis (most effective would be stereotactic delivery)
58
Q

What is the max dose the liver can recieve before radiation hepatitis?

A
  • 30Gy
59
Q

What are the side effects of hepatic cancer and treatment?

A
  • nausea and vomiting
60
Q

What is the patient care for hepatic cancer?

A
  • 5-HT antagonist antiemetics with or without steroids

- bilirubin, prothrombin time and albumin must be monitored

61
Q

Where is the gallbladder located?

A
  • below the lower border of the liver

- in contact with the anterior abdominal wall at the transpyloric plane

62
Q

What is the gallbladders main function?

A
  • store bile which helps with the body break down and digest fats
  • presence of fatty foods in the body with trigger the gallbladder to squeeze its bile concentrate into the small intestine
63
Q

What are the primary biliary tumours?

A
  • gallbladder

- cholangiocarcinoma

64
Q

What is a cholangiocarinoma?

A
  • arises from the ductal epithelium of the bilary tree

- rare

65
Q

What is the epidemiology of gallbladder cancer?

A
  • equal M:F ratio
  • older then 65
  • chile, Japan and northern india
  • gallstones, liver flukes
  • 10% 5 yr survival rate
66
Q

What are the signs and symtoms of gallbladder cancer?

A
  • right upper quadrant pain
  • in advanced cases (nausea, vomitting, weight loss, obstructive jaundice)
  • asymptomatic tumour and advanced stage usually diagnosed by signs and symptoms of gallstones and chronic inflammation
67
Q

What are the different types of gallbladder cancer and %?

A
  • in body and cystic duct (4%)
  • adenocarcinomas (85%)
  • anaplastic (6%)
  • squamous (5%)
68
Q

Where does gallbladder cancer commonly spread?

A
  • lymphatics (coeliac and aortic nodes)
  • hepatic mets
  • seed into peritoenum –> invade liver
69
Q

What is the management of cholangiocarcinoma?

A
  • surgical resection is the only curative treatment
  • biliary stenting
  • 5yr survival rate <5%
  • EBRT effective for pain relief and relieve obstructive jaundice
70
Q

What is the management of gallbladder cancer?

A
  • surgical excision
  • chemo-radiation
  • intrabiliary stenting
  • combination cisplatin and gemcitabine (chemo) show significant improvement of survivial rates
71
Q

What is the side effects and patient care for gallbladder cancer?

A
  • nausea and vomitting
  • controlled with antiemetics (zofran, odancetron)
  • with or without steriods (help with anti-inflammatory)

RT Yr 2 Sem 1 (5 decks)

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