wk 7 2 Pathology of oesophagus and stomach

Question 1

layers in oesophagus

Answer 1

mucosa (layered squamous, basement, lamina propria)
muscularis mucosa
submucosa
muscularis propria (aventitia)

Question 2

2 main cancers of oesophageal cancer, where abouts is incidence higher for each

Answer 2

squamous cell carcinoma (east/developing world)

adenocarcinoma (west,caucasian)

Question 3

4 factors which lead to oesophageal cancer

Answer 3

reflux
obesity
smoking
diet low in fruits and veg

Question 4

outline how the extent of barrets is measured

Answer 4

recognise hiatus hernia if present
locate gastro-oesophageal junction, measure depth on endoscopy
look for initia discplacement from junction, measure C
measure last sign of barrets, measure M
subtract each from junction marker, getting Cx and My

Question 5

outline how a normal oesophagus can develop into adenocarcinoma

Answer 5

squamous oesophagus (injury, bile reflux, NO)
chronic inflammation
barrets metaplasia (layered squamous - columnar epithelium)
low-grade dysplasia
high-grade dysplasia
Invasive adenocarcinoma

Question 6

how is oesophageal cancer diagnosed 2

Answer 6

if new onset dysphagia >55 = endoscopy

mucosal abnormality in at least 6 biopsies = endoscopy

Question 7

3 things used to stage oesophageal cancer

Answer 7

CT - chest ab, pelvis
PET-CT - more sensitive for distal nodal disease (metastases)
Endoscopic ultrasound - more sensitive for regional (local) nodal disease

Question 8

for oesophageal cancer, how many lymph nodes require metastasis for N2

Answer 8

N2 = 3-6

n1=1-2,n3=7+

Question 9

stage IIb of oesophageal cancer TNM

Answer 9

T1/2
N1
M0 (35% survival)

Question 10

when the tumour develops through the submucosa, what stage is it at

Answer 10

1b
(2 = through circular muscle
3= through longlitudinal
4 = into outer tissue 
5 = into next structure)

Question 11

what is the treatment for squamous cell carcinoma

Answer 11

localised SCC - radical chemoradiotherapy

no surgery

Question 12

adenocarcinoma with no evidence of metastases + no co-morbidities the patient would recieve 2

Answer 12

oesophagectomy +/- neoadjuvant chemotherapy

Question 13

adenocarcinoma is T1a, they would recieve

Answer 13

endoscopic resection

Question 14

most common cause of gastric cancer

Answer 14

H pylori

Question 15

how is gastric cancer diagnosed

Answer 15

endoscopy

early symptoms non-specific (ingestion, fatigue, bloating, ab pain, weight loss)

Question 16

t/f good results with chemotherpy for gastric cancer

Answer 16

false

no metastases = surgery