FN: Gastrointestinal Surgery Oesophageal Cancer Flashcards Preview

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Flashcards in FN: Gastrointestinal Surgery Oesophageal Cancer Deck (10):
1

Epi

Incidence:12/100,000 increasing (increasing Barrett’s prevalence)
Age: 50-70 yrs
Sex: M>F = 5:1

2

Risk Factors

EtOH
Smoking
Achalasia
GORd → Barretts
Plummer-Vinson
Fatty diet
Reduced Vit A + C
Nitrosamine exposure

3

Pathophysiology

65% adenocarcinoma
• Lower 3rd
• GORD → Barrett’s → dysplasia → Ca

35% SCC
• Upper and middle 3rds
• Assoc. with EtOH and smoking
• Commonest type worldwide

4

Presentation

Progressive dysphagia: solids → liquids (esp. bread)
→Often alter dietary habit → soft food → exacerbation of wt. loss
• Wt. loss
• Retrosternal chest pain
• Lymphadenopathy
• Upper 3rd:
→ Hoarseness: recurrent laryngeal N. invasion
→ Cough ± aspiration pneumonia

5

Spread

Direct extension, lymphatic’s and blood
75% of pts have mets @ Diagnosis

6

Bloods

FBC: anaemia
LFTs: hepatic mets, abumin

7

Diagnosis

Upper GI endoscopy:aloows biopsy
Ba swallow: not often used, apple-core stricture

8

Staging

TNM:
• CT
• EUS
• Laparoscopy/mediastinoscopy: mets

9

Treatment:

1. Oesophagectomy
2. Palliative
a. Majority of pts.
b. Laser coagulation
c. Alcohol injection + reduced ascites (spiro)
d. Stening and Secretion reduction (e.g. hycosine patch)
e. Analgesia e.g. fentanyl patches
f. Radiotherapy: external or brachytherapy
g. Referral
i. Palliative care team
ii. Macmillian nurses

10


Benign Tumours:

• Leiomyoma
• Lipmoas
• Haemangiomas
• Beningn polyps

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