Flashcards in Oesophagus and Stomach 1 and 2 - Oesophageal and Gastric Tumours, Oesophageal Conditions 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 - GORDSquamous cell carcinoma (proximal oesophagus) - smoking and drinking
signs and symptoms of oesophageal cancer? (8)
dysphagia:where the patient feels food sticking isn't necessarily where the tumour isodynophagiaupper GI haemorrhageanaemiaweight lossretrosternal painif upper tumour, cough and hoarseness
What should be performed if you suspect oesophageal cancer? e.g. presence of dysphagia
An urgent upper GI endoscopyAlso 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 intentAssess patient fitnessAccurate staging
What is performed to accurately stage an oesophageal cancer?
CT thorax/ abdomen - if normal perform tests belowCT/PET, EUS, Laparoscopy (can spread intra-abdominally causing little seedlings in the abdomen - laparoscopy searches for this)search hard for metastatic diseaseif metastases present = palliative care
Palliative treatment options for oesophageal cancer? (3)
ChemotherapyRadiotherapyStenting - 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 diseaseRadical chemoradiotherapy - complications are more manageable
What are the adverse prognostic factors for oesophageal cancer? (3)
Oesophageal obstructionTumour longer than 5cmMetastatic disease
Staging of oesophageal cancer using TNM?
Tis = carcinoma in situT1 = invading lamina propria/ submucosaT2 = invading muscularis propriaT3 = Invading adventitiaT4 = invasion of adjacent structuresNx = nodes cannot be assessedNO = no node spreadN1 = regional node metastasise M0 = no distant spreadM1 = distant metastasis
What types of gastric cancers do you get? (5)What is the most common type?
Adenocarcinoma - commonest typeRarer:lymphoma - better prognosisGastrointestinal Stomal Tumours - rarely metastasise = better prognosisSquamous cell carcinoma Neuroendocrine tumours
Signs and symptoms of gastric cancer? (10)
DysepsiaUpper GI bleedingAnaemiaweight lossAbdominal massAnorexia/ early satietyvomitingHepatomegalyjaundiceascites
How do you accurately stage a gastric cancer?
CT thorax/ abdomenLaparoscopy/ EUS
Palliative treatment for gastric cancer? (3)
ChemotherapyRadiotherapySurgical palliation e.g. for obstruction(Trastuzamab for Her-2 positive tumours)
Treatment for potentially curable gastric cancer?
surgery with or without NACsurgery 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)?
metastatic diseaseshort historyadvanced ageproximal lesions locally advanced lesionsuperficial 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 properlyIncrease in intra-abdominal pressureGastric acid hyper secretion
What type of people have a higher chance of getting GORD? (4)
Pregnant peopleObese peopleSmokersIncreased association with alcohol
Symptoms of GORD?
Heartburn (burning retrosternal discomfort after meals, lying, stooping or straining)belchingacid brash (acid/ bile regurgitation)Waterbrash (increased salivation)odynophagia (pain on swallowing e.g. from oesophagitis)nocturnal asthmachronic coughlaryngitissinusitis
Complications of GORD?
OesophagitisUlcerationBenign strictureIron-deficiencyBarrett’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 erosion1 = more than or equal to 1 mucosal break, 5mm long but not extending beyond 2 mucosal fold tops3 = mucosal break continuous between the tops of 2 or more mucosal folds but which involves less than 75% of the oesophageal circumference4 = mucosal break involving greater than or equal to 75% of the oesophageal circumference
Treatments fo GORD?
Physically repair the defective valve (surgery)H2 receptor antagonistsPPIsAnti-acids
What causes achalasia?
Lower oesophageal sphincter fails to relx
Symptoms of achalasia? (4)
DysphagiaregurgitationSubsternal crampsWeight loss
Diagnosis of achalasia?
CXR (fluid level in dilated oesophagus)Barium swallow (dilated tapering oesophagus