Oesophago-gastric cancer

Question 1

Cancers affecting the oesophagus and their causes?

Answer 1

Adenocarcinoma - caused by reflux disease, eventually leading to Barrett’s oesophagus (dysplasia) and then to malignancy

Squamous cell carcinoma - caused by smoking and alcohol

Question 2

Cancers affecting the stomach and their causes?

Answer 2

Adenocarcinoma:
H. pylori (class I carcinogen)
Environmental factors

Lymphoma
GISTs (Gastrointestinal Stromal Tumours) - soft tissue sarcoma; they rarely metastasise

Question 3

Signs and symptoms of oesophageal cancer?

Answer 3

Dysphagia - most common presentation (site of blockage may be different from where it is felt)

Odynophagia - pain on swallowing
Upper GI haemorrhage causes - anaemia
Weight loss

Question 4

Signs and symptoms of gastric cancer?

Answer 4

People often present late:
Dyspepsia/indigestion - this is suspicious if it affects somebody suddenly who has previously never had it
Upper GI haemorrhage causes anaemia
Weight loss
Abdominal mass
Anorexia/early satiety
Vomiting

Question 5

Investigations for oesophago-gastric cancer?

Answer 5

Urgent upper GI endoscopy - do not refer high dysphagia to ENT

Colonoscopy

Question 6

Determining treatment for oesophageal cancer?

Answer 6

Stage the cancer using:
CT of the thorax/abdomen
CT/PET, EUS (endoscopic ultrasound) or laparoscopy
Search hard for metastatic disease, e.g: CT scan can show liver metastases

Potentially curative
OR
Palliative

To help, consider the patient’s fitness, as potentially curative regimes are taxing

Question 7

Treatments for oesophageal cancer?

Answer 7

Palliative:
Chemotherapy
Radiotherapy
Stenting - never gives the normal sensation of swallowing

Potentially curative:
Surgery with/without NAC (better for early disease)
Radical chemoradiotherapy - more manageable as half of all people with surgery will have complications

Question 8

Determining treatment for gastric cancer?

Answer 8

Largely the same as for oesophageal cancer but CT/PET and EUS are not used much

Gastric cancer is assoc. with a high recurrence rate

Question 9

Treatment of gastric cancer?

Answer 9

Palliative:
Chemotherapy - poor response
Radiotherapy

Potentially curative:
Surgery with/without NAC - this is the only treatment that is potentially curative

Question 10

Adverse prognostic factors in oesophageal cancer?

Answer 10

Oesophageal obstruction
Tumour longer than 5 cm
Metastatic disease

Question 11

Adverse prognostic factors in gastric cancer?

Answer 11

Metastatic disease
Short history
Advanced age
Proximal lesion - becoming more common and assoc. with more complications
Locally advanced lesion
Superficial gross appearance (linitis plastica - rare type of gastric cancer)