Upper GI cancer

Question 1

What is Barrett’s oesophagus?

Answer 1

An abnormal change (metaplasia) in the cells of the lower portion of the esophagus. When the normal stratified squamous epithelium lining of the esophagus is replaced by simple columnar epithelium with goblet cells (cells usually found lower in the gastrointestinal tract), Barrett’s esophagus is diagnosed. The medical significance of Barrett’s esophagus is its strong association with esophageal adenocarcinoma, a particularly lethal cancer.
Main cause = an adaptation to chronic acid exposure from reflux esophagitis.
Diagnosis = endoscopy and biopsy. clinical history and examination.

Question 2

What is oesophageal cancer?

Answer 2

• more common in > 65 yrs • 7,000 new cases/year UK

* 35% female • Two aetiological subtypes: Squamous cell cancer and Adenocarcinoma

Question 3

What are the causes of adenocarcinoma?

Answer 3

• Obesity & gastro-oesophageal reflux • Smoking & alcohol • Barrett’s oesophagus

Question 4

What are the causes of squamous cell cancer?

Answer 4

• Diet Nitrosamines,
Vitamins A & C, riboflavin & protein • Smoking & alcohol
• Leukoplakia, achalasia, webs

Question 5

What’s the epidemiology of gastric cancer?

Answer 5

20 per 100,000 UK
> 65 years
predominately male 
poor socio-economic status 
high incidence in far East

Question 6

What are the causes of gastric cancer?

Answer 6

• Gastritis
• Pernicious anaemia
• Previous gastric surgery
• Helicobacter infection
• Dietary factors, low fresh fruit
• Smoking
• Blood group A
• Family history (E-cadherin mutation)

Question 7

What are the symptoms of oesophageal and gastric cancer?

Answer 7

Local disease:
• Dysphagia
• Chest pain 
• Dyspepsia 
• Haematemesis 
• Vomiting

Advanced disease:
• Weight loss 
• Lymph nodes
• Ascites 
• Hoarseness 
• Epigastric mass

Question 8

How can you stage upper GI cancer?

Answer 8

• Computed tomography scan
• Endoluminal ultrasound scan
• Laparoscopy

Question 9

What’s radical treatment for oesophageal cancer?

Answer 9

Oesophagectomy alone
Pre-operative chemotherapy
Tri-modality treatment
Primary chemotherapy & radiotherapy

Question 10

Palliative care for malignant dysphagia?

Answer 10

Endoscopic stent placement
Tumour destruction
Palliative chemotherapy
Palliative radiotherapy

Question 11

What are the complications of stent insertion?

Answer 11

Oesophageal perforation 
Stent migration 
Tumour overgrowth/ingrowth 
Blockage
Disintegration

Question 12

What’s radical treatment for gastric cancer?

Answer 12

Surgery alone
Total gastrectomy
Subtotal gastrectomy
D2 lymphadenectomy

Question 13

Palliative care for gastric cancer?

Answer 13

Treat blood loss
Remove gastric outlet obstruction
Improve dysphagia

Question 14

In summary…

Answer 14

• Serious malignancy
• Tumours of OG junction increasing
• Treatment is challenging
• Multi-disciplinary teams
• Earlier diagnosis essential