You're browsing as an anonymous user. Join the community today to view notes at your university, edit pages, and share knowledge!

GI Cancer

From Mediwikis

Upper GI Cancer

The two main types of upper GI cancer are outlined below: Oesophageal and Gastric Cancer.

Oesophageal Cancer

Poor prognosis. 5 year survival is around 13% with the number of cases in the UK increasing.[1]

Presenting Complaint

  • Weight Loss
  • Dysphagia - difficulty swallowing


  • Squamous Carcinoma
    • Risk Factor - Smoking
    • Location - Upper and Middle Third of Oesophagus
  • Adenocarcinoma
    • 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


  • Chemoradiotherapy
  • Surgical management

Gastric Cancer

Incidence decreasing, (M>F). As with pancreatic cancer, gastric cancer often presents late. Poor Prognosis with 5 year survival around 17%.[3]

Risk Factors - atrophic gastritis, H. pylori (as it leads to a chronic inflamation of the stomach - gastritis), high salt diet

Presenting Complaint

  • 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.


  • Endoscopy
  • 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.

Risk Factors:

  • 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

Presenting Complaint

  • 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)


  • Colonoscopy
  • CT - chest, abdomen, pelvis - to look for metastatic disease
  • Pelvic MRI - to help plan surgery
  • Monitor CEA (Carcinoembryonic Antigen)

Pancreatic Cancer

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)


  1. http://www.cancerresearchuk.org/cancer-help/type/oesophageal-cancer/treatment/statistics-and-outlook-for-oesophageal-cancer
  2. 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
  3. http://www.cancerresearchuk.org/cancer-info/cancerstats/types/stomach/survival/stomach-cancer-survival-statistics