Oesophageal and Gastric Cancer

Question 1

What types of cancer affects the oesophagus

Answer 1

Squamous cell

Adenocarcinoma = most common

Question 2

What is TNM staging of oesophageal cancer

Answer 2

T1A = mucosa
T1b = sub-mucosa
T2 = muscle 
T3 = adventitia (outer layer) 
T4 = attached to organ e.g. aorta / pleura / trachea

Question 3

Why is important o differentiate between T1 and T2 and how do you do this

Answer 3

Different treatment

EUS used if local disease no mets

Question 4

Why does oesophagus not have serosa

Answer 4

Not covered by peritoneum

Question 5

What is a squamous cell tumour like

Answer 5

Large occluding
Proximal and middle
Dysplasia before
Wart like

Question 6

What is an adenocarcinoma like

Answer 6

Distal oesophagus as due to GORD / Barret
Present late
Fleshy

Question 7

What is the most common presenting symptom

Answer 7

Progressive dysphagia

Solid then liquid

Question 8

What are other symptoms /

Answer 8

Weight loss
Anorexia
Vomiting during eating 
Odynophagia
Chest pain / heart burn 
Haematemesis 
Cough / hoarse 
Pneumonia due to regurgitation 
Vocal cord paralysis

Question 9

What causes pneumonia

Answer 9

Trachea-oesophageal fistula or regurgitation

Question 10

What causes cough / hoarse / vocal cord paralysis

Answer 10

Damage to L recurrent laryngeal nerve or trachea invaded

Question 11

Where does oesophageal cancer spread too

Answer 11

Liver in adenocarcinoma
Brain
Lungs
Bone

Question 12

What are other complications of oesophageal cancer

Answer 12

Ulceration
Perforation
Abscess due to perforation
Stricture

Question 13

What are the RF for oesophageal cancer

Answer 13

Age 
Smoking
Alcohol 
Diet 
HPV

Question 14

What is adenocarcinoma associated with

Answer 14

Male 
Caucasian
Obesity - hernia 
GORD 
Barret's

Question 15

What is squamous associated with

Answer 15

Diet
Achalasia
Plummer Vinson Syndrome

Question 16

What is Plummer Vinson Syndrome

Answer 16

Anaemia - iron deficient
Atrophic glossitis
Dysphagia secondary to web

Question 17

What is gold standard for Dx oesophageal cancer

Answer 17

Endoscopy + biopsy

Question 18

What else can you do

Answer 18

Barium swallow - used for motility but may pick up

EUS with CT / MRI to stage

Question 19

How do you stage

Answer 19

FBC, U+E, LFT
CT CAP 
MRI
Laparoscopy if suspicion of peritoneal spread 
Bone scan

Question 20

What do you do if laparotomy -ve

Answer 20

PET

If primary does not light up then no mets will

Question 21

How do you treat dysplasia

Answer 21

Endoscopic ablation

Question 22

How do you treat 1a

Answer 22

Endoscopic mucosal reaction
Can’t do for 1b
Mucosa won’t separate from sub-mucosa

Question 23

What do you do for T1b / T2

Answer 23

Neoadjuvant Chemo
Surgical oesophagostomy
Radical RT / chemo

Question 24

What is only curative for Adenocarcinoma

Answer 24

Surgery

Question 25

Why neoadjuvant chemo

Answer 25

Most upper GI presents with mets

Question 26

What do you do for palliation which is 70%

Answer 26

``` Stent Laser PEG Nutrition Intubation Chemo / RT ```

Question 27

What do you do if Plummer Vinson

Answer 27

Iron supplement | Dilatation of web

Question 28

What are complications of surgery

Answer 28

``` Chronic volume reflux Infection Anastomotic leak = mediastinitis Arrythmia Lose LOS - small meals often Perforation General risks ```

Question 29

What do you get after op

Answer 29

Feeding jejuonstomy to allow time to heal

Question 30

How does gastric cancer arise

Answer 30

Gastritis Intestinal metaplasia Dysplasia Cancer

Question 31

What causes

Answer 31

H.ployri | Unknown

Question 32

What are the RF

Answer 32

``` Male >55 HNPCC / FAP Smoking H.pyloi Ulcer Previous gastric resection Polyps FH Blood group A Gastritis Reflux Pernicious anaemia Low fibre, high flat ```

Question 33

What are the symptoms

Answer 33

``` Dyspepsia Persistent pain Early satiety Blaoting N+V Weight loss Melena Anaemia ``` ``` Signs suggests incurable Upper abdominal mass HSM AScites Jaundice Obstruction Large left supraclavicular node (Virchow's) Acanthosis nigrican's ```

Question 34

How does gastric cancer spread

Answer 34

Direct Lymphatic Blood to liver Trans-colemic within peritoneal cavity

Question 35

What is 1st line investigation

Answer 35

Endoscopy + biopsy | Barium swallow may show

Question 36

How do you stage

Answer 36

EUS for depth CT.MRI for staging laparoscopy for locally advanced / cytology of peritoneal washing PET CT

Question 37

How do you treat

Answer 37

Neo-adjuvant chemo Gastrectomy Surgical palliation for obstruction / pain

Question 38

What do you have to do after surgery

Answer 38

Small meals often | Vitamin supplement

Question 39

What are complications after surgery

Answer 39

``` Infection Bleeding Vomiting B12 deficiency Iron deficiency Vitamin deficiency Impaired protein digestion as lack of pepsin Lack of sterilisation Bacterial overgrowth Malabsorption Osteoporosis / osteomalacia Weighth loss Early satiety Dumping syndrome ```

Question 40

What is dumping syndrome

Answer 40

``` Fluid shift and distension as can't digest food so rapid transit Dizzy Flushing / sweating Fast HR N+V Abdo pain Hypoglycaemia due to rapid glucose absorption and insulin release Diarrhoea as increased osmotic pull ```