Upper GI tumours Flashcards
What types of oesophageal cancers can you get?
Squamous cell carcinoma
Adenocarcinoma
Which region of the oesophagus do squamous cell carcinomas usually affect?
Middle third
Which region of the oesophagus do adenocarcinomas usually affect?
Lower third
What are the risk factors for oesophageal carcinoma?
Smoking Alcohol excess Obesity Ingestion of very hot food + drinks Coeliac disease Pre-existing oesophageal disease: strictures, achalasia
What disease is the pre-malignant phase of oesophageal adenocarcinoma?
Barret’s oesophagus: metaplasia of the normal squamous epithelium into columnar epithelium
What are the clinical features of oesophageal carcinoma?
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
Why does oesophageal carcinoma sometimes cause hoarseness?
If the cancer is in the top third of the oesophagus, it might interfere with the recurrent laryngeal nerve
Investigations of oesophageal carcinoma?
OGD: to look for tumours in oesophagus
Biopsy: look for signs of neoplasia
Barium swallow: show up any areas narrowed by tumour
What is an OGD?
Oesophago-gastro-duodenoscopy
What method do you use to stage oesophageal cancer?
TNM
Tumour
Lymph node involvement
Metastasis
Treatment of oesophageal carcinoma?
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
What is the prognosis like for oesophageal cancer?
Poor, people often present too late with disease that is locally advanced or metastatic disease
10% 5 year survival
What can you do to relieve symptoms in someone with inoperable oesophageal carcinoma?
Implant a stent in the oesophagus to relieve dysphagia
Describe the progression of normal oesophageal epithelium to cancerous oesophageal epithelium?
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
What type of gastric cancers can you get?
Adenocarcinomas Squamous cell cancers Lymphoma Gastrointestinal stromal tumours Neuro-endocrine tumours
Where are tumours most commonly seen in the stomach?
In the antrum
The bit before the bit next to the duodenum
Which type of gastric cancer is most commonly seen?
Adenocarcinoma
What are the risk factors for gastric cancer?
H. pylori infection
Lifestyle:
- smoking
- alcohol
- poor diet, lots of processed food
Pernicious anaemia
Family history of gastric cancer
Adenocarcinomas come in two types, what are they?
Localised: ulcerated lesions with rolled edges
Diffuse: extensive sub-mucosal spread
Clinical features of gastric cancer?
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
Why does stomach cancer cause anaemia?
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
What are some signs of metastasis that occur in gastric cancer?
Palpable lymph nodes
Liver + peritoneum spread
- ascites
- hepatomegaly
Skin manifestations:
- dermatomyositis
- acanthosis nigricans: thickened darkened skin
What is dermatomyositis?
Inflammation of the skin and underlying muscle tissue
Degeneration of collagen, discoloration, and swelling
What is acanthosis nigricans?
Development of darkened, thickened patches of skin
Often harmless but if they develop quickly they could be a sign of malignancy
Investigations of gastric cancer?
Gastroscopy (OGD)
Biopsy
Cytology of peritoneal washing: look for signs of malignancy in cells washed out of peritoneum, could be metastasis
Management of gastric cancer?
Surgical resection is best option
Also give chemotherapy as adjuvant therapy
Sometimes palliative care is the best option, control symptoms
What type of palliative care can you give for gastric cancer?
Chemotherapy to shrink tumour and improve survival and quality of life
Surgery to reduce the symptoms the tumour is causing
What is a gastro-intestinal stromal tumour (GIST)?
Tumour of stromal (connective) tissue or of mesenchymal tissue
Where are GISTs most commonly seen?
Stomach
Proximal small intestine
Are GISTs benign or malignant?
Most of them become malignant
Clinical features of GISTs?
Asymptomatic, often found incidentally
They ulcerate and bleed
Treatment of GISTs?
Surgical resection
Imatinib: an anti-cancer drug
What is gastric lymphoma?
Tumour of lymphatic cells in the stomach
What is MALToma?
Another name of gastric lymphoma
It stands for mucosa associated lymphoid tissue
How does gastric lymphoma present?
Similar to gastric adenocarcinoma:
- Epigastric pain
- Dyspepsia
- Nausea
- Anorexia
- Weight loss
What causes most gastric lymphomas?
H. pylori!
Management of gastric lymphomas?
Some can be treated by eradication of H. pylori
Others require chemo and radiotherapy
