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Medicine Notes Gastrointestinal (GI) System Notes

Cancer Of The Upper Gi Tract Notes

Updated Cancer Of The Upper Gi Tract Notes

Gastrointestinal (GI) System Notes

Gastrointestinal (GI) System

Approximately 57 pages

These notes helped me achieve a mark of 73% in my GI exam, which is the equivalent of a 1st. The notes are based on a series of lectures on the subject. They are very clearly laid out and easy to follow. They cut out unnecessary information on the topic, making the notes very concise, and fast to get through. Anyone studying medicine, or any other subject requiring knowledge of the GI tract (e.g. physiology or anatomy), would benefit greatly from these notes. There are lecture in the series on th...

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The following is a more accessible plain text extract of the PDF sample above, taken from our Gastrointestinal (GI) System Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Lecture 10

Cancer of the upper GI tract

  • Anatomy of oesophagus

    • 25cm in posterior mediastinum

    • Cricopharyngeus to stomach

    • Muscular wall, no serosa

    • Aortic branches

    • Vagus innervation

    • Squamous lining, columnar at OGJ

  • Cancer of the oesophagus (two types)

    • 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

    • 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

    • UK definition

      • “ Oesophagus in which portion of normal squamous lining replaced by metaplastic columnar epithelium visible macroscopically”

    • 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

    • 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

      • Endoscopic mucosal resection

      • Radiofrequency ablation (hope tissue grows back normally, not columnar)

  • Oesophageal cancer

    • Symptoms

      • Local disease (by time you see these, usually too advanced)

        • Dysphagia

        • Chest pain

        • Dyspepsia (indigestion)

        • Haematemesis

      • Advanced disease

        • Weight loss

        • Hoarseness

        • Appetite loss

    • Oesophageal cancer- signs (all really signs of advanced disease)

      • Cachetic

      • Nodes in neck

      • Ascites

      • Epigastric mass

    • Staging oesophageal cancer

      • TNM system

        • T stage

          • T1- invades lamina propria or submucosal

          • T2- invades muscularis propria

          • T3- invades adventitia

          • T4- invades adjacent structures

        • N stage

          • N0- no nodal involvement; N1- involvement

        • M stage

          • M0- no metastasis; M1-metastases present

        • Stage IIA, IIB, III= treatment. Stage IV= metastatic and can’t cure

      • Ways of staging

        • Clinical examination; CT; Endoluminal US scan; Position emission tomography; Selective laparoscopy; Selective bronchoscopy

    • Oesophageal cancer-...

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