Flashcards in Oesophago-gastric cancer Deck (22):
1
What happens to the cells of the lower oesophagus with reflux disease and why?
The squamous epithelium turn to columnar cells to try and resist the acidic environment
2
What can occur with persistant reflux and what can this cause?
Barratts oesophagus leading to adenocarcinoma
3
What causes squamous cell carcinoma?
excessive use of smoking or alcohol
4
Name the 3 changes in cells leading to adneocarcinoma
Metaplasia, dysplasia, adenocarcinoma
5
How does gastric adenocarcinoma arise as?
Presence of H Pylori combined with other genetic factors
6
Where do Gastro Intestinal stomal tumours develop
In the wall of the stomach - not the lining of the epithelium
7
Name the 3 types of gastric cancer
Adenocarcinoma
Lymphoma
GISTs
8
What are the 3 types of Junctional Cancers and what type of cancers are they?
Oesophageal
True junctional
Gastric
All adenocarcinomas
9
What are the signs and symptoms of oesophageal cancer
Dysphagia
Odynophagia
Haematemesis, Regurgitation, dysphonia
Weight loss
Adenopathy, pleural effusions, hepatomegaly (metastasis)
Paraneoplastic syndrome
Lymphadenopathy in the superclavicular junction around the carotid arteries
10
What are the signs and symptoms of gastric cancer?
Dyspepsia - abdo pain, emesis, anorexia, dysphagia
Upper GI haemorrhage
Weight loss
Abdo mass
Jaundice (if metastasis)
Paraneoplastic syndromes
11
How can we diagnose oesophageal cancer
Weight loss
Lymph nodes
Liver
Upper GI endoscopy AND BIOPSY!
Barium meal
CT or MRI of chest and abdo
Endoscopic ultrasound for patients who are likely to rquire surgery
12
What does an Endoscopic ultrasound show?
The lymph node location and state
13
How can we diagnose gastric cancer
Weight loss
lymph nodes
Abdominal mass
Upper GI endoscopy AND BIOPSY
Barium meal
CT scan
14
What are the alarm features of GI cancer
Over 55 years
Dysphagia
Evidence of GI blood loss
Persistent vomiting
Unexplained weight loss
Upper abdominal mass
Anaemia
15
WHat is the life expectancy when GI cancer has metastasised
1- 3 months on average
16
What is the treatment for oesophageal treatment?
Palliation of oesophageal obstruction and improve survival
Only chance of cure is surgery
Removal of oesophagus and lymph nodes
17
Who is not suitable for surgery for oesophageal cancer
50% of patients
Not T4 or M1 diagnosis
Not long tumours
Not cervical lymph node patients
18
What are the contraindications to surgery for oesophageal cancer
Direct invasion of adjacent structures (trachea or bronchus)
Fixed cervical lymph nodes
Widespread metastases
Poor general health
19
What are the other forms of treatment for oesophageal cancer?
Palliative Radiotherapy
Intubation / stents
Canalisation - dilation
Photo-dynamic therapy
Alcohol injections (dry up cells)
Terminal care
20
What is the treatment options for gastric cancer?
SUrgery - palliation of symptoms
improved survival
via an abdo op
remove involved organs
Radiotherapy
Chemotherapy
Intubation of proximal lesions
21
What is the prognosis of oesophageal cancer?
11% 5 year survival rate for all patients
Patients who have surgery have a much higher survival rate
22