upper and lower GI cancer

1. more common in Japan, E europe, China, S america
2. assoc: pernicioius anmia, blood group A, H pylori, atrophic gastritis, adenomatous polyps, lower social class, smoking, diet (high nitrate, high salt, pickling, low vit C, nitrosamine exposure, E cadherin abnorms
3. symps
   1. often NON-SPECIFIC
   2. dyspepsia (for >1mo + >50y demands investig), weight loss, vomiting, dysphagia, anemia
4. signs
   1. suggesting incurable disease: epigastric mass, hepatomeg, jaundice, ascites, large Virchow's node, acanthosis nigricans
5. spread
   1. local, lymphatic, blood, transcelimic (eg to ovaries)
6. tests
   1. gastroscopy
   2. multiple ulcer edge biopsies- aim to biopsy all gastric ulcers
   3. endoscopic USS and CT/MRI for staging
7. treat
   1. surgical resection or total gastrectomy
      1. combo chemo may increase survival if advanced
   2. palliation for obstruct, pain, hemorrage
   3. 5 year surviv <10% overall (but radical surgery increases to 20%)

1. RFs: diet, alch excess, smoking, achalasia, Plummer-vinson synd, obesity, diet low in vit A and C, nitrosamine exposure, reflux esophagitis +/- Barret's esoph, Male: F 5:1
2. may be squamous cell or adenocarcinomas
3. symps/signs
   1. dysphagia, weight loss, retrosternal chest pain, lymphadenopathy (rare), hoarseness, cough
4. tests
   1. barium swall, CXR, esophagoscopy w/biopsy/brushings/EUS, CT/MRI, stagin laparoscopy if significant infra-diaphragmatic component
5. treat
   1. poor survival w/ or w/o treat
   2. can try radical curative oesophagectomy
   3. palliation: aims to restore swallowing w/ chemo/radiotherapy, stenting and laser use

Annotations:

• dukes claffic A confined to beneath musc mucosa B extension thru musc mucosa C local LNs involved D distant mets

1. 3rd most common cancer, 2nd most common cancer deaths. 56% in ppl >70years
2. RFs: neoplastic polyps, UC Crohns, familial adenomatous polyposis, HNPCC, previous cancer, low-fibre diet, smoking. (family history)
3. presentation
   1. Lsided: bleeding/mucus PR, CoBH or obstruction, tenesmus, mass PR
   2. Right: weigh loss, Hb --, abdo pain, (obstruct less likely)
   3. both: abdo mass, perf, hameorrhage, fistula
4. tests
   1. FBC(microcytic anemai), fecal occult blood, sigmoidoscopy, bariumn enema or colonoscopy (or done by CT), LFT, CT/MRI, liver USS.
5. spread: local, lymphatic by blood (liver, lung, bone) or transcoelomic
6. treatment
   1. surgery
      1. curative: hemicolectomy or resection (depends on site)
         1. radiotherapy pre-op
      2. palliative: endoscopic stenting
      3. prognosis: 60% amenable to radical surgery; 70% of these alive 7 years
   2. chemotherapy
      1. Dukes C (reduce mortality)
      2. palliative in metastatic