Flashcards in Oesophago-gastric cancer Deck (22)
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
What can occur with persistant reflux and what can this cause?
Barratts oesophagus leading to adenocarcinoma
What causes squamous cell carcinoma?
excessive use of smoking or alcohol
Name the 3 changes in cells leading to adneocarcinoma
Metaplasia, dysplasia, adenocarcinoma
How does gastric adenocarcinoma arise as?
Presence of H Pylori combined with other genetic factors
Where do Gastro Intestinal stomal tumours develop
In the wall of the stomach - not the lining of the epithelium
Name the 3 types of gastric cancer
What are the 3 types of Junctional Cancers and what type of cancers are they?
What are the signs and symptoms of oesophageal cancer
Haematemesis, Regurgitation, dysphonia
Adenopathy, pleural effusions, hepatomegaly (metastasis)
Lymphadenopathy in the superclavicular junction around the carotid arteries
What are the signs and symptoms of gastric cancer?
Dyspepsia - abdo pain, emesis, anorexia, dysphagia
Upper GI haemorrhage
Jaundice (if metastasis)
How can we diagnose oesophageal cancer
Upper GI endoscopy AND BIOPSY!
CT or MRI of chest and abdo
Endoscopic ultrasound for patients who are likely to rquire surgery
What does an Endoscopic ultrasound show?
The lymph node location and state
How can we diagnose gastric cancer
Upper GI endoscopy AND BIOPSY
What are the alarm features of GI cancer
Over 55 years
Evidence of GI blood loss
Unexplained weight loss
Upper abdominal mass
WHat is the life expectancy when GI cancer has metastasised
1- 3 months on average
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
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
What are the contraindications to surgery for oesophageal cancer
Direct invasion of adjacent structures (trachea or bronchus)
Fixed cervical lymph nodes
Poor general health
What are the other forms of treatment for oesophageal cancer?
Intubation / stents
Canalisation - dilation
Alcohol injections (dry up cells)
What is the treatment options for gastric cancer?
SUrgery - palliation of symptoms
via an abdo op
remove involved organs
Intubation of proximal lesions
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