Upper GI surgery Flashcards
cause of adenocarcinomas
Distal oesophagus
Obesity
Gastro-oesophageal reflux
Barrett’s metaplasia
Dysplasia -> Carcinoma
squamous cell carcinoma
Proximal and middle third oesophagus
Smoking
Alcohol
Low socio-economic status
osophageal cancer warning signs
- frequent and persistent coughing
- acid indigestion, heartburn, reflux
- difficulty when swalloing food
- constant burping
- pain between shoulder blades
- weight loss
investigation for osophageal cancer
endoscopy
swallow
how is osophageal cancer staged
(TNM) CT Chest/Abdomen
what is staging algorithm for metastatic/unfit patients
No further staging required
Palliative/Supportive therapy
what is staging algorithm for resectable/fit patients
EUS
T/N stage
PET CT
M stage
what are treatment options for metastatic/unfit patients
Stenting
Palliative radiotherapy
Palliative chemotherapy
is radiotherapy more effective on squamous or adenocarcinomas
squamous cell carcinomas
treatment options for resectable cancer patients
Oesophagectomy + Chemotherapy
5 year survival approx 45%
Concerns about resection/fitness and no metastatic disease
Chemo/Radiotherapy
5 year survival approx 30%
what are the approaches for oesophagectomy
Ivor Lewis
Trans-hiatal
Left thoraco-abdominal
oesophagectomy conduit
Stomach
Colon
what is the morbidity and mortality rate for oesophageal cancer
Morbidity 20-30%
Mortality 5%
what are the modifiable risk factors for gastric cancer
alcohol
H.Pylori
Smoking
Excessive consumption of salted fish, pickled vegetables, cured meats
presentation of gastric cancer
anemia
loss of weight
anorexia
recent onset of progressive symptoms
masses and melaena/haematemesis
swallowing difficulties
