- 1 Upper GI Cancer
- 2 Lower GI Cancer - Colorectal Cancer
- 3 Pancreatic Cancer
- 4 References
Upper GI Cancer
The two main types of upper GI cancer are outlined below: Oesophageal and Gastric Cancer.
Poor prognosis. 5 year survival is around 13% with the number of cases in the UK increasing.
- Weight Loss
- Dysphagia - difficulty swallowing
- Squamous Carcinoma
- Risk Factor - Smoking
- Location - Upper and Middle Third of Oesophagus
- Risk Factor - Chronic GORD (Gastro-Oesophageal Reflux Disease)
- Location - Lower Third of Oesophagus
- Premalignant State - Barrett's Oesophagus (where stratified squamous epithelium of the oesophagus undergoes metaplasia to form a more resistant columnar epithelium due to chronic acid exposure)
- Endoscopy with TOE (transoesophageal ultrasound - looks for local invasion)
- CT to give a better idea of invasion and staging
- Surgical management
Incidence decreasing, (M>F). As with pancreatic cancer, gastric cancer often presents late. Poor Prognosis with 5 year survival around 17%.
Risk Factors - atrophic gastritis, H. pylori (as it leads to a chronic inflamation of the stomach - gastritis), high salt diet
- Weight Loss
- Vomiting - as there is an obstruction in the stomach and food cannot exit normally through the pylorus
- Anaemia - due to chronic GI bleeding
A rare sign that may be seen in gastric cancer patients is a paraneoplastic syndrome called acanthosis nigricans.
- CT for staging and to look for invasion
Lower GI Cancer - Colorectal Cancer
Increasing incidence, M>F. Prognosis is much improved if it is detected early.
- Long standing polyps - especially if they are large
- Ulcerative Colitis - patients with long standing UC should undergo regular checks for colorectal cancer
- Family History of Colorectal Cancer - especially those with a familial form of colorectal cancer (HNPCC - Heriditary Non Polyposis Colorectal Cancer, autosomal dominant inheritance; and FAP - Familial Adenonomatous Polyposis)
- Poor, low fibre diet
- Change in bowel habit
- Weight Loss
- Iron Deficiency Anaemia - due to chronic GI bleeding
- PR bleeding
- Subacute Bowel Obstruction - main feature being pain that comes and goes in waves (colicky)
- CT - chest, abdomen, pelvis - to look for metastatic disease
- Pelvic MRI - to help plan surgery
- Monitor CEA (Carcinoembryonic Antigen)
This type of cancer has a particularly poor prognosis, with mean survival being around 6 months. One of the problems is that it notoriously presents late. Usually it is an adenocarcinoma.
Risk factors include smoking and poor diet (with a high fat content).
Tends to be a vague history with anorexia and fatigue. More specific signs depend on the location of the cancer:
- Head of the Pancreas - around half of all pancreatic cancer. Presents with painless obstructive jaundice.
- Body of the Pancreas - around a quarter of all pancreatic cancer. Presents with weight loss, pain and diabetes (as the insulin producing islet cells are destroyed and replaced with adenocarcinoma)
- Tail of the Pancreas - Present especially late with metastases usually to the liver
- Ultrasound of abdomen
- CT abdomen
- MRCP (Magnetic Resonance Cholangio-Pancreatography) - this is used to see bile ducts
- Tumour marker - Ca 19-9 (keep in mind the level may be raised in other GI cancers, bile duct disease and liver disease)
- Best LMJ, Mughal M, Gurusamy KS. Non-surgical versus surgical treatment for oesophageal cancer. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD011498. DOI: 10.1002/14651858.CD011498.pub2<http://dx.doi.org/10.1002/14651858.CD011498.pub2