Presentation is loading. Please wait.

Presentation is loading. Please wait.

Upper Gastro-Intestinal Malignancies Dr Paddy Niblock Consultant Clinical Oncologist 13 th October 2010.

Similar presentations


Presentation on theme: "Upper Gastro-Intestinal Malignancies Dr Paddy Niblock Consultant Clinical Oncologist 13 th October 2010."— Presentation transcript:

1 Upper Gastro-Intestinal Malignancies Dr Paddy Niblock Consultant Clinical Oncologist 13 th October 2010

2 Sites Oesophagus Stomach

3 Oesophageal Cancer – Incidence UK 4000 deaths/year Male (2) : Female (1) Peak 60-80 years Median 72 years Increasing prevalence Geographical variation

4 Oesophageal Cancer - Incidence

5

6 Oesophageal Cancer - Aetiology

7 Oesophageal Cancer – Aetiology Smoking Alcohol Barrett’s Tylosis palmaris Chemical/Radiation exposure Achalasia Obesity Diet

8 Oesophageal cancer - Symptoms Alarm Symptoms: (Refer for early endoscopy) Dysphagia } Vomiting}60-85% Anorexia} Weight loss}60-70% GI blood loss}20-40%

9 Oesophageal Cancer - Diagnosis Barium swallow Upper GI endoscopy + biopsy

10 Diagnosis - Barium Swallow

11 Diagnosis - Upper GI Endoscopy

12 Oesophageal Cancer - Pathology

13 Oesophageal Cancer - Classification Squamous carcinoma Adenocarcinoma –Type 1 Intestinal metaplasia of tubular oesophagus –Type 2 True junctional tumours of the gastric cardia –Type 3 Subcardial tumours which infiltrate superiorly

14 Oesophageal Cancer - Staging Investigations Routine CT EUS Selected CXR Abdominal US MRI Bronchoscopy Laparoscopy PET

15 Staging – CT scan

16 Staging - EUS

17 Staging – EUS

18 Oesophageal Cancer - TNM Staging Primary Tumour (T) invades T1l.propria/submucosa T2m.propria T3 adventitia T4adjacent structures Regional LNs (N) N11/2 nearby nodes N23-6 nearby nodes N3>7 nearby nodes Metastases (M) M1 distant spread

19 Oesophageal Cancer – Treatment Multidisciplinary Approach Surgery Radiotherapy Chemotherapy Stent

20 Oesophageal Cancer - Surgery A) Ivor-Lewis approach resulting in an anastomosis in the chest B) Three-field oesophagectomy with anastomosis in the neck, C) Transhiatal approach, avoids a thoracotomy.

21 Surgery cont. Other approaches –Endoscopic mucosal resection –Limited resection for early disease –Laparoscopic oesophagectomy AIM : R0 resection

22 However …. Irrespective of histology 5 year OS with surgery alone 5 – 20%

23 Radiotherapy

24 High energy photon X-rays CT plan patient in treatment position Targeted to include tumour +/- nodes Treats microscopic disease Radical v palliative

25 Radiotherapy - Side Effects Fatigue Dysphagia / odynophagia Nausea Skin reaction

26 Chemotherapy Neoadjuvant / Peri-operative Concurrent with radiotherapy Palliative

27 Other Treatments Palliative Brachytherapy Stents Laser / PDT Dilation

28 Oesophageal Stent

29 Survival

30 Gastric Cancer - Incidence 6th commonest cancer in men 7th in women Male (3) : Female (2) Declining incidence Geographical variation

31 Gastric Cancer - Aetiology Diet H. pylori Smoking F.A.P. Barrett’s oesophagitis Pernicious Anaemia

32 Helicobacter pylori

33 Gastric Cancer – Diagnosis UGIE Japanese routinely screen

34 Upper GI Endoscopy T1

35 Gastric Cancer T2N1

36 Linitis Plastica

37 Gastric Cancer - Pathology Adenocarcinomas90% Lymphomasup to 8% Leiomyosarcomas1-3% GISTs

38 Gastric Cancer – Staging CT EUS Laparoscopy

39 Gastric Cancer – Treatment Multidisciplinary Approach Surgery Chemotherapy Radiotherapy

40 Treatment - Curative SURGERY Stomach Oesophagogastrectomy Gastrectomy Partial gastrectomy Nodes Limited (UK) Extensive (Japan) CHEMOTHERAPY Consider peri-operative chemotherapy in fit patients

41 Treatment - Chemotherapy Peri-operative survival advantage in fit patients Palliative

42 Treatment - Palliative Radiotherapy Bleeding Painful bone metastases Chemotherapy Stents Laser Surgery

43 Useful Websites www.sign.ac.uk www.cancerbacup.org.uk


Download ppt "Upper Gastro-Intestinal Malignancies Dr Paddy Niblock Consultant Clinical Oncologist 13 th October 2010."

Similar presentations


Ads by Google