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Gastrointestinal > Upper GI tumours > Flashcards

Upper GI tumours Flashcards

1
Q

What types of oesophageal cancers can you get?

A

Squamous cell carcinoma

Adenocarcinoma

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2
Q

Which region of the oesophagus do squamous cell carcinomas usually affect?

A

Middle third

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3
Q

Which region of the oesophagus do adenocarcinomas usually affect?

A

Lower third

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4
Q

What are the risk factors for oesophageal carcinoma?

A 
Smoking
Alcohol excess
Obesity
Ingestion of very hot food + drinks
Coeliac disease
Pre-existing oesophageal disease: strictures, achalasia
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5
Q

What disease is the pre-malignant phase of oesophageal adenocarcinoma?

A

Barret’s oesophagus: metaplasia of the normal squamous epithelium into columnar epithelium

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6
Q

What are the clinical features of oesophageal carcinoma?

A

Progressive dysphasia: goes from unable to swallow solids to unable to swallow anything, due to the growth of the tumour

Weight loss

Retrosternal chest pain

GI bleeding

Hoarseness + cough if upper third of oesophagus is affected

Signs of metastasis
Para-neoplastic syndrome

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7
Q

Why does oesophageal carcinoma sometimes cause hoarseness?

A

If the cancer is in the top third of the oesophagus, it might interfere with the recurrent laryngeal nerve

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8
Q

Investigations of oesophageal carcinoma?

A

OGD: to look for tumours in oesophagus

Biopsy: look for signs of neoplasia

Barium swallow: show up any areas narrowed by tumour

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9
Q

What is an OGD?

A

Oesophago-gastro-duodenoscopy

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10
Q

What method do you use to stage oesophageal cancer?

A

TNM

Tumour
Lymph node involvement
Metastasis

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11
Q

Treatment of oesophageal carcinoma?

A

Surgical resection ideally performed before tumour infiltrates the oesophageal wall

Combined with chemotherapy and sometimes radiotherapy

Often too late: palliative care and relief of symptoms

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12
Q

What is the prognosis like for oesophageal cancer?

A

Poor, people often present too late with disease that is locally advanced or metastatic disease

10% 5 year survival

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13
Q

What can you do to relieve symptoms in someone with inoperable oesophageal carcinoma?

A

Implant a stent in the oesophagus to relieve dysphagia

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14
Q

Describe the progression of normal oesophageal epithelium to cancerous oesophageal epithelium?

A

Oesophageal squamous epithelium

Gastro-oesophageal reflux causes metaplasia to glandular columnar epithelium

Continued reflux causes abnormal growth (dysplasia) of glandular epithelium

Continued reflux results in neoplastic oesophageal glandular epithelium: cancer

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15
Q

What type of gastric cancers can you get?

A 
Adenocarcinomas
Squamous cell cancers
Lymphoma
Gastrointestinal stromal tumours
Neuro-endocrine tumours
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16
Q

Where are tumours most commonly seen in the stomach?

A

In the antrum

The bit before the bit next to the duodenum

17
Q

Which type of gastric cancer is most commonly seen?

A

Adenocarcinoma

18
Q

What are the risk factors for gastric cancer?

A

H. pylori infection

Lifestyle:

  • smoking
  • alcohol
  • poor diet, lots of processed food

Pernicious anaemia
Family history of gastric cancer

19
Q

Adenocarcinomas come in two types, what are they?

A

Localised: ulcerated lesions with rolled edges

Diffuse: extensive sub-mucosal spread

20
Q

Clinical features of gastric cancer?

A

Pain: similar to peptic ulcer pain

Dyspepsia
Nausea
Anorexia
Weight loss
Anaemia
Palpable mass

Tumours may cause obstruction and therefore vomiting, dysphagia

Signs of metastasis
Para-neoplastic syndrome

21
Q

Why does stomach cancer cause anaemia?

A

Due to bleeding of tumour causing blood loss

ALSO
Intrinsic factor is produced by parietal cells in stomach.
This is needed for absorption of B12 in s. intestine

B12 is needed for formation of red blood cells

Cancer causes reduced secretion of intrinsic factor, less B12

22
Q

What are some signs of metastasis that occur in gastric cancer?

A

Palpable lymph nodes

Liver + peritoneum spread

  • ascites
  • hepatomegaly

Skin manifestations:

  • dermatomyositis
  • acanthosis nigricans: thickened darkened skin
23
Q

What is dermatomyositis?

A

Inflammation of the skin and underlying muscle tissue

Degeneration of collagen, discoloration, and swelling

24
Q

What is acanthosis nigricans?

A

Development of darkened, thickened patches of skin

Often harmless but if they develop quickly they could be a sign of malignancy

25
Q

Investigations of gastric cancer?

A

Gastroscopy (OGD)

Biopsy

Cytology of peritoneal washing: look for signs of malignancy in cells washed out of peritoneum, could be metastasis

26
Q

Management of gastric cancer?

A

Surgical resection is best option

Also give chemotherapy as adjuvant therapy

Sometimes palliative care is the best option, control symptoms

27
Q

What type of palliative care can you give for gastric cancer?

A

Chemotherapy to shrink tumour and improve survival and quality of life

Surgery to reduce the symptoms the tumour is causing

28
Q

What is a gastro-intestinal stromal tumour (GIST)?

A

Tumour of stromal (connective) tissue or of mesenchymal tissue

29
Q

Where are GISTs most commonly seen?

A

Stomach

Proximal small intestine

30
Q

Are GISTs benign or malignant?

A

Most of them become malignant

31
Q

Clinical features of GISTs?

A

Asymptomatic, often found incidentally

They ulcerate and bleed

32
Q

Treatment of GISTs?

A

Surgical resection

Imatinib: an anti-cancer drug

33
Q

What is gastric lymphoma?

A

Tumour of lymphatic cells in the stomach

34
Q

What is MALToma?

A

Another name of gastric lymphoma

It stands for mucosa associated lymphoid tissue

35
Q

How does gastric lymphoma present?

A

Similar to gastric adenocarcinoma:

  • Epigastric pain
  • Dyspepsia
  • Nausea
  • Anorexia
  • Weight loss
36
Q

What causes most gastric lymphomas?

A

H. pylori!

37
Q

Management of gastric lymphomas?

A

Some can be treated by eradication of H. pylori

Others require chemo and radiotherapy

Gastrointestinal (20 decks)

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