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Flashcards in Upper GI cancer Deck (14)

What is Barrett's oesophagus?

An abnormal change (metaplasia) in the cells of the lower portion of the esophagus. When the normal stratified squamous epithelium lining of the esophagus is replaced by simple columnar epithelium with goblet cells (cells usually found lower in the gastrointestinal tract), Barrett's esophagus is diagnosed. The medical significance of Barrett's esophagus is its strong association with esophageal adenocarcinoma, a particularly lethal cancer.
Main cause = an adaptation to chronic acid exposure from reflux esophagitis.
Diagnosis = endoscopy and biopsy. clinical history and examination.


What is oesophageal cancer?

• more common in > 65 yrs • 7,000 new cases/year UK
• 35% female • Two aetiological subtypes: Squamous cell cancer and Adenocarcinoma


What are the causes of adenocarcinoma?

• Obesity & gastro-oesophageal reflux • Smoking & alcohol • Barrett’s oesophagus


What are the causes of squamous cell cancer?

• Diet Nitrosamines,
Vitamins A & C, riboflavin & protein • Smoking & alcohol
• Leukoplakia, achalasia, webs


What's the epidemiology of gastric cancer?

20 per 100,000 UK
> 65 years
predominately male
poor socio-economic status
high incidence in far East


What are the causes of gastric cancer?

• Gastritis
• Pernicious anaemia
• Previous gastric surgery
• Helicobacter infection
• Dietary factors, low fresh fruit
• Smoking
• Blood group A
• Family history (E-cadherin mutation)


What are the symptoms of oesophageal and gastric cancer?

Local disease:
• Dysphagia
• Chest pain
• Dyspepsia
• Haematemesis
• Vomiting

Advanced disease:
• Weight loss
• Lymph nodes
• Ascites
• Hoarseness
• Epigastric mass


How can you stage upper GI cancer?

• Computed tomography scan
• Endoluminal ultrasound scan
• Laparoscopy


What's radical treatment for oesophageal cancer?

Oesophagectomy alone
Pre-operative chemotherapy
Tri-modality treatment
Primary chemotherapy & radiotherapy


Palliative care for malignant dysphagia?

Endoscopic stent placement
Tumour destruction
Palliative chemotherapy
Palliative radiotherapy


What are the complications of stent insertion?

Oesophageal perforation
Stent migration
Tumour overgrowth/ingrowth


What's radical treatment for gastric cancer?

Surgery alone
Total gastrectomy
Subtotal gastrectomy
D2 lymphadenectomy


Palliative care for gastric cancer?

Treat blood loss
Remove gastric outlet obstruction
Improve dysphagia


In summary...

• Serious malignancy
• Tumours of OG junction increasing
• Treatment is challenging
• Multi-disciplinary teams
• Earlier diagnosis essential