1
Lecture
Medicine
Cancer of the GI tract
General aspects
Does it matter?
Bowel cancer second most common cause of cancer death
Incidence rates stable since the 90s
Mostly diagnosed at a late stage
Anatomy
Digestive tract is just a long tube which runs through organs
o Oesophagus
o Stomach
o Pancreas
o Colon and rectum
Most important ones for this purpose
Symptom complexes
Insidious
o Discovered at advanced stages
o Widely spread
Bleeding
o Overt
Blood in vomit or stool
o Occult
Anaemia
Pain
o Blockages
Due to tumour growth
o Invasion
By tumours of the walls and adjacent organs
Alteration of flow
o Dysphagia
o Constipation
o Diarrhoea
Weight loss
Pain in intestinal obstruction
Central
Visceral
Poorly localised
Depends on location
o Foregut
Epigastric
o Midgut
Periumbilical
o Hindgut
Suprapubic
Relates to embryology of the areas of intestine
o Different parts are irrigated by different branches of the aorta
Pathology
, 2
Lecture
Medicine
Columnar epithelium
Adenocarcinomas
o Glandular
Squamous
o Oesophagus
o Anus
Spread locally first
Then invade walls of the intestine
Also spread to lymph nodes
Can invade adjacent organs
Blood borne
o Can spread to liver and lungs
Aetiology
Multifactorial
o Genetic
o Diet
Gastric cancers more important
Processed foods and fats
o Environmental
o Chemical
Alcohol
Smoking
o Inflammation
Usually affect people of middle and older age
Slight male predominance
o some exceptions
Treatment
Surgery
Radiotherapy, chemotherapy, biotherapy
Survival
Based on stage at time of diagnosis
Localised and easy to remove have good prospects for cure
o Goes down dramatically if spreads outside of local area
Oesophageal cancer
Squamous cell carcinomas
o Middle 1/3
o Associated with alcohol and smoking
o Associated with caustic injury
o Poverty
o Increased risk with deficient diet
o Higher rates in some countries
Adenocarcinomas
o Lower 1/3 into cardia
o Less frequent
o On the rise in western countries
o Barret’s oesophagus
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