Esophageal and Gastric Cancers Flashcards
What type of cancer is most common in the “Esophageal cancer belt.”
primarily squamous cell histology; attributed to smoking, ingestion of really hot beverages and poor nutrition
What are the risk factors for squamous cell carcinoma?
“field concretization effect”- chronic inflammatory irritation
smoking, alcohol, lye ingestion, HPV, HNSCC, other dietary factors (pickled foods)??
What are the risk factors for adenocarcinoma?
male gender
obesity
chronic GERD
***Barrett esophagus
What are the most common symptoms of esophageal cancer?
dysphagia (significant- by the time people have dysphagia, most often T3 or greater tumor, most often with nodal involvement)
weight loss
bleeding/melenic stools
these should be followed up with an upper endoscopy with biopsy (endoscopic ultrasound to evaluate nodes and CT/PET to evaluate for metastatic dz)
What is the therapy for localized disease
pre and post operative chemotherapy and radiotherapy with surgery (esophagectomy with gastric pullup)
note with surgery patients will never lie flat again as the LES is removed
What is the goal in managing metastatic disease?
short course radiotherapy or esophageal stenting to improve symptoms
What is the primary type of gastric cancer?
primarily adenocarcinoma (can also be GIST, MALToma, NET)
What risk factors are attributed to the geographical variety in gastric cancer epidemiology?
H. pylori
high salt, high nitrate foods, poorer food prep
atrophic gastritis
low SES
hereditary syndromes (ie. hereditary diffuse gastric cancer)
(east asian incidence of gastric cancer has up to 10x of that of USA)
Contrast the two different subtypes of gastric cancers.
intestinal: mass-like, intraluminal, prone to bleeding and high association with H. pylori
diffuse: often submucosal, presents with early satiety (inability to expand), often presents in late stage
What are the symptoms and signs of gastric cancer?
abdominal pain weight loss nausea blotting bleeding/melena ? ulcers refractory to PPI/triple/quad therapy
dx with EGD and tissue biopsy
What is involved in surgical therapy of gastric cancer?
partial or total gastrectomy depending on size and location of tumor, type of lymph node dissection is hotly debated
chemotherapy pre and post -op provides tumor shrinkage and a time test for metastases
in US D1 resection includes resection of local LN and omentum (more conservative than Asian D2)
prognosis still hovers around 1yr
What palliative needs should you consider with gastric cancer?
challenge to overcome pain and nausea
hyperalimentation not helpful
early involvement of palliative care team is important
What are risk factors for pancreatic adenocarcinoma?
increasing age smoking obesity diabetes? maybe familial syndromes: FAP (ampullary)
Name some signs and symptoms of pancreatic cancer?
jaundice (due to biliary obstruction) epigastric pain radiating to the back new onset diabetes weight loss nausea and vomitting palpable gallabladder
ERCP and endoscopic ultrasound can help in diagnosis
Wh is staging important in pancreatic cancer?
level of tumor involvement around the SMA is important for prognosis and surgical resection
(encasement is a locally advanced cancer)
treated with a Whipple, adjuvant gemcitabine may improve outcome
