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384681
upper and lower GI cancer
Description
FOCP- GI Mind Map on upper and lower GI cancer, created by greenfylde on 24/11/2013.
No tags specified
focp- gi
focp- gi
Mind Map by
greenfylde
, updated more than 1 year ago
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Created by
greenfylde
over 10 years ago
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Resource summary
upper and lower GI cancer
gastric
more common in Japan, E europe, China, S america
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
symps
often NON-SPECIFIC
dyspepsia (for >1mo + >50y demands investig), weight loss, vomiting, dysphagia, anemia
signs
suggesting incurable disease: epigastric mass, hepatomeg, jaundice, ascites, large Virchow's node, acanthosis nigricans
spread
local, lymphatic, blood, transcelimic (eg to ovaries)
tests
gastroscopy
multiple ulcer edge biopsies- aim to biopsy all gastric ulcers
endoscopic USS and CT/MRI for staging
treat
surgical resection or total gastrectomy
combo chemo may increase survival if advanced
palliation for obstruct, pain, hemorrage
5 year surviv <10% overall (but radical surgery increases to 20%)
esophageal
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
may be squamous cell or adenocarcinomas
symps/signs
dysphagia, weight loss, retrosternal chest pain, lymphadenopathy (rare), hoarseness, cough
tests
barium swall, CXR, esophagoscopy w/biopsy/brushings/EUS, CT/MRI, stagin laparoscopy if significant infra-diaphragmatic component
treat
poor survival w/ or w/o treat
can try radical curative oesophagectomy
palliation: aims to restore swallowing w/ chemo/radiotherapy, stenting and laser use
colorectal
Annotations:
dukes claffic A confined to beneath musc mucosa B extension thru musc mucosa C local LNs involved D distant mets
3rd most common cancer, 2nd most common cancer deaths. 56% in ppl >70years
RFs: neoplastic polyps, UC Crohns, familial adenomatous polyposis, HNPCC, previous cancer, low-fibre diet, smoking. (family history)
presentation
Lsided: bleeding/mucus PR, CoBH or obstruction, tenesmus, mass PR
Right: weigh loss, Hb --, abdo pain, (obstruct less likely)
both: abdo mass, perf, hameorrhage, fistula
tests
FBC(microcytic anemai), fecal occult blood, sigmoidoscopy, bariumn enema or colonoscopy (or done by CT), LFT, CT/MRI, liver USS.
spread: local, lymphatic by blood (liver, lung, bone) or transcoelomic
treatment
surgery
curative: hemicolectomy or resection (depends on site)
radiotherapy pre-op
palliative: endoscopic stenting
prognosis: 60% amenable to radical surgery; 70% of these alive 7 years
chemotherapy
Dukes C (reduce mortality)
palliative in metastatic
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