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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

Types

  • 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)

Investigations

  • Endoscopy with TOE (transoesophageal ultrasound - looks for local invasion)
  • CT to give a better idea of invasion and staging

Management[2]

  • 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.

Investigations

  • 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)

Investigations

  • 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).

Presentation

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

Investigations

  • 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)


References

  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