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Cancer Of The Upper Gi Tract Notes

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Lecture 10 Cancer of the upper GI tract

Anatomy of oesophagus o 25cm in posterior mediastinum o Cricopharyngeus to stomach o Muscular wall, no serosa o Aortic branches o Vagus innervation o Squamous lining, columnar at OGJ Cancer of the oesophagus (two types) o Squamous cell cancer
 In western world, incidence decreasing (still high in east)
 Aetiology

• Cigarettes & alcohol (highest risk factors, combined= x20 risk)

• Diet (low in fruit & veg, nitrosamines, vit. A & C, riboflavin &
protein)

• Plummer- Vinson syndrome (iron d. anaemia & dysplasia) RARE

• Tylosis (thickening of skin on palms and soles) RARE

• Achalasia

• Eating/drinking scolding hot things increases risk o Adenocarcinoma
 Increasing incidence in western world
 Majority of oesophageal cancer seen (80-90%)
 Aetiology

• Barrett's oesophagus (caused by GORD0

• GORD

• BMI (overweight=increased risk)

• Smoking and alcohol

• Occupation

• Radiotherapy

• H. pylori= protective against adenocarcinoma Barrett's oesophagus o UK definition
 " Oesophagus in which portion of normal squamous lining replaced by metaplastic columnar epithelium visible macroscopically" o Malignant risk
 Specialised intestinal metaplasia (0.4-0.6% per year- low risk)
 Low grade dysplasia (0.8-1.6% per year)
 High grade dysplasia (6-12% per year- High risk and treat using endoscopy)
 Invasive adenocarcinoma o Treatment
 Control symptoms & reduce complications (meds or surgery- don't know if stops cancer progression)
 Proton pump inhibitors or anti-reflux surgery
 Endoscopic dilatation if stricture
 Endoscopic surveillance

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