Flashcards in *Oesophageal and Stomach Disorders (lectures 1 and 2) Deck (27)
What are the 2 possible types of oesophageal cancer?
What is the most common?
Where is each more likely to occur?
what are the main things that increase the incidence of each type?
Adenocarcinoma (distal oesophagus) - more common - GORD
Squamous cell carcinoma (proximal oesophagus) - smoking and drinking
signs and symptoms of oesophageal cancer? (8)
where the patient feels food sticking isn't necessarily where the tumour is
upper GI haemorrhage
if upper tumour, cough and hoarseness
What should be performed if you suspect oesophageal cancer? e.g. presence of dysphagia
An urgent upper GI endoscopy
Also perform a colonoscopy if the patent presents with anaemia
What 3 things should be done to help choose treatment for oesophageal and gastric cancers?
Determine treatment intent
Assess patient fitness
What is performed to accurately stage an oesophageal cancer?
CT thorax/ abdomen - if normal perform tests below
CT/PET, EUS, Laparoscopy (can spread intra-abdominally causing little seedlings in the abdomen - laparoscopy searches for this)
search hard for metastatic disease
if metastases present = palliative care
Palliative treatment options for oesophageal cancer? (3)
Stenting - not very pleasant to swallow with
Treatment options for oesophageal cancer that can be potentially cured?
Surgery with or without NAC - offers better cure rates for early disease
Radical chemoradiotherapy - complications are more manageable
What are the adverse prognostic factors for oesophageal cancer? (3)
Tumour longer than 5cm
Staging of oesophageal cancer using TNM?
Tis = carcinoma in situ
T1 = invading lamina propria/ submucosa
T2 = invading muscularis propria
T3 = Invading adventitia
T4 = invasion of adjacent structures
Nx = nodes cannot be assessed
NO = no node spread
N1 = regional node metastasise
M0 = no distant spread
M1 = distant metastasis
What types of gastric cancers do you get? (5)
What is the most common type?
Adenocarcinoma - commonest type
lymphoma - better prognosis
Gastrointestinal Stomal Tumours - rarely metastasise = better prognosis
Squamous cell carcinoma
Signs and symptoms of gastric cancer? (10)
Upper GI bleeding
Anorexia/ early satiety
How do you accurately stage a gastric cancer?
CT thorax/ abdomen
Palliative treatment for gastric cancer? (3)
Surgical palliation e.g. for obstruction
(Trastuzamab for Her-2 positive tumours)
Treatment for potentially curable gastric cancer?
surgery with or without NAC
surgery based treatment is the only potentially curative option
radiotherapy is not a treatment option for gastric cancers as the stomach is too big an organ and therefore you would poison the patient with radiotherapy
Adverse prognostic factors for gastric cancer (6)?
locally advanced lesion
superficial gross appearance (limits plastica)
What is gastro-oesophageal reflux disease?
Reflux of stomach contents which causes troublesome symptoms and/or complications
What causes GORD? (3)
Lower oesophageal sphincter doesnt work properly
Increase in intra-abdominal pressure
Gastric acid hyper secretion
What type of people have a higher chance of getting GORD? (4)
Increased association with alcohol
Symptoms of GORD?
Heartburn (burning retrosternal discomfort after meals, lying, stooping or straining)
acid brash (acid/ bile regurgitation)
Waterbrash (increased salivation)
odynophagia (pain on swallowing e.g. from oesophagitis)
Complications of GORD?
Barrett’s oesophagus = increased chance of oesophageal cancer
What type of classification is used to classify GORD?
Los Angeles Classification
Loss Angeles Classification?
“mucosal break” = a well-demarcated area of slough/ erythema) - used to encompass the old terms ulceration and erosion
1 = more than or equal to 1 mucosal break, 5mm long but not extending beyond 2 mucosal fold tops
3 = mucosal break continuous between the tops of 2 or more mucosal folds but which involves less than 75% of the oesophageal circumference
4 = mucosal break involving greater than or equal to 75% of the oesophageal circumference
Treatments fo GORD?
Physically repair the defective valve (surgery)
H2 receptor antagonists
What causes achalasia?
Lower oesophageal sphincter fails to relx
Symptoms of achalasia? (4)
Diagnosis of achalasia?
CXR (fluid level in dilated oesophagus)
Barium swallow (dilated tapering oesophagus