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ESOPHAGEAL CANCER
8th most common cancer in the world
2 common forms of EC
1. Squamous cell carcinoma
2. Adenocarcinoma
Squamous cell carcinoma
Squamous cell (thin, flat cells lining the esophagus)
Upper and middle pain of the esophagus
Adenocarcinoma
Glandular (secretory) cells
Lower part of the esophagus, near the stomach
Risk factors
Heavy alcohol use
Older age
Tobacco use
Barrett esophagus cells lining the lower part of the esophagus have
changed
GERD backing of stomach contents into the lower section; may cause
Barretts Esophagus overtime
Signs and Symptoms
Dysphagia
Weight loss
Bleeding
Pain behind the breastbone
Hoarseness and cough
Indigestion and heat burn
Hepatomegaly
Lymphadenopathy
Pathophysiology
Arises in the mucosa of the esophagus
Invade submucosa and muscular layer
Staging
Stage 0
abnormal cells in the innermost layer of tissue lining the
esophagus
Stage 1
cancer formed and spread beyond the innermost layer to the
next layer
Stage 2
spread to the layer of esophageal muscle
Stage 3
spread to the outer wall of the esophagus
Stage 4A
spread to nearby or distant lymph nodes
Stage 4B
spread to organs in other parts of the body
Diagnosis
Esophagogastroduodectomy
Endoscopic ultrasonography
periesophageal lymph nodes
Computed tomography
BLADDER
Sits just under the liver
Stores bile
Bile helps digest fats
When u remove gallbladder it results to diarrhea and malabsorption
Risk factors
Gallstones
Pebble like collections of cholesterol
Porcelain gallbladder covered with calcium deposits, occurs after long term
inflammation of gall bladder, cholecystitis caused by gallstones
Obesity
Female
Signs and symptoms
Nausea
Abdominal pain
Jaundice
Lumos in the belly
Weight loss
Loss of appetite
Diagnosis
Test of liver and gallbladder function
Bilirubin chemical that gives the bile its yellow color
Tumor markers CEA CA19-9 proteins found in the blood when certain cancers
are present
Treatment
Surgery
Potentially curative surgery good chance of removing all the cancer
Palliative surgery relieve pain and prevent complications
Chemotherapy
Fluouracil
Capecitabine
STOMACH CANCER
Stomach holds food and start to digest it
Duodenum first part of intestine
Parts of stomach
Cardia first portion
Fundus upper part of the stomach next to cardia
Corpus main part, also called as body
Anthrum lower portio near intestine, food is mixed with gastric juice
Pylorus last part acts as a ball to control emptying of the stomach contents
into the small intestine
Proximal stomach makes acid and pepsin, makes a protein called intrinsic factor
Diagnosis
Endoscope
Mouth guard prevents from endoscopic from damaging
Treatments
Surgery used in all stages of gastric cancer
endoscopic resection for very early stage cancers
subtotal gastrectomy only part of the stomach is removed
total gastrectomy end of the esophagus is attached to part of the small
intestine
Chemotherapy
5fu with leucovirin
Capicitabin (Xeloda)
Carboplatin
Cisplatin
Doxipaxel (taxotere)
Apirubicin (ellence)
Irinotican (camptosar)
Oxaliplatin (eloxatin)
Paclitaxel (taxol)
Radiation therapy
delay or prevent cancer recurrence after surgery
Slow the growth and ease of the symptoms of advanced stomach cancer
Targeted therapy
Stage 1
surgery
o Gastric bypass
o Subtotal gastrectomy
Stage 2
Stage 3
o
o
Chemo-radiation
Targeted therapy
Trastuzumab (Herceptin)
Ramucirumab (cyramza)
4 nutrition
Nutritional counseling and tpn
Stage
COLON CANCER
Colorectal cancer (also known as colon cancer, rectal cancer, or bowel cancer) is the
development of cancer from the colon or rectum (parts of the large intestine). It is
due to the abnormal growth of cells that have the ability to invade or spread to
other parts of the body
Etiology
Genetic Syndromes
o most common of these is hereditary nonpolyposis colorectal cancer (HNPCC
or Lynch syndrome) which is present in about 3% of people with colorectal
cancer.
o Gardner syndrome
o Familial adenomatous polyposis (FAP).
1. Lynch syndrome (HNPCC or hereditary nonpolyposis colorectal cancer)
o Accounts for 3% of all colon cancer
o Age less that 50 or strong family history
o Skips the polyp step in cancer formation
o Those with the gene have an 80% chance of developing colon cancer
o High risk of uterine cancer
2. Gardner Syndrome
o also known as familial colorectal polyposis
o autosomal dominant form of polyposis characterized by the presence of
multiple polyps in the colon together with tumors outside the colon
o caused by mutation in the APC gene located in chromosome 5q21 (band q21
on chromosome 5).
3. Familial adenomatous polyposis
o inherited condition in which numerous adenomatous polyps form mainly in
the epithelium of the large intestine.
o start out benign, malignant transformation into colon cancer occurs when
they are left untreated.
Clinical Manifestation
o Signs and symptoms of colorectal cancer can be extremely varied, subtle,
and nonspecific.
o Patients with early-stage colorectal cancer are often asymptomatic, and
lesions are usually detected by screening procedures.
o Blood in the stool is the most common sign
o change in bowel habits
o vague abdominal discomfort
Diagnosis
o When colorectal carcinoma is suspected, a careful personal and family history
and physical examination should be performed
o The entire large bowel should be evaluated by colonoscopy or flexible
sigmoidoscopy with double-contrast barium enema
Staging
Stage I
Stage II.
Stage III
Stage IV
Your cancer has grown through the superficial lining (mucosa) of the
colon or rectum but hasn't spread beyond the colon wall or rectum.
Your cancer has grown into or through the wall of the colon or rectum
but hasn't spread to nearby lymph nodes.
Your cancer has invaded nearby lymph nodes but isn't affecting other
parts of your body yet.
Your cancer has spread to distant sites, such as other organs for
instance, to your liver or lung
Early-stage
o Removing polyps during colonoscopy.
o Endoscopic mucosal resection.
o Minimally invasive surgery.
Surgery for invasive colon cancer
Partial colectomy
o Surgery to create a way for waste to leave your body
o removes the part of your colon that contains the cancer, along with a margin
of normal tissue on either side of the cancer. Your surgeon is often able to
reconnect the healthy portions of your colon or rectum.
Targeted drug therapy
Bevacizumab (Avastin)
o First line treatment
o Angiogenesis inhibitor
o Inhibiting vascular endothelial growth factor
o (VEGF-A)
o Acute Toxicity : HTN
o Delayed Toxicity:
Arterial thromboembolic events
GI perforation
Wound healing complication
Proteinuria
VEGF-A is a chemical signal that stimulates angiogenesis in a variety of
diseases, especially in cancer. Bevacizumab was the first clinically
available angiogenesis inhibitor in the United States.
Cetuxumab (Erbitux)
Tests
TNM Stage:
Stage IA (T1N0M0) The tumor is confined to the pancreas and is 2 cm across the
pancreas or smaller
N0-M0 cancer has not spread to nearby lymphnodes or distant
sites
Stage IB (T2N0M0) T2- cancer has not grown OUTSIDE the pancreas but is larger
than 2 cm
Stage IIA (T3N0)
beyond the pancreas T3- cancer has grown OUTSIDE the
pancreas into nearby surrounding structures but not into nearby
blood vessls or nerves
Stage IIB (T1-3N1M0)
N1- cancer has spread to nearby lymphnodes
Stage III (T4)
Unresectable
Cancer has spread to the major blood vessels near the pancreas.
These include the superior mesenteric artery, celiac axis,
common hepatic artery, and portal vein.
Stage IV
Metastasis
Chemotherapy
Chemotherapy for Metastatic Pancreas Cancer
FOLFIRINOX (oxaliplatin (Eloxatin), irinotecan (Camptosar) , leucovorin,
fluorouracil)
Gemzar (gemcitabine) + Abraxane (albumin bound paclitaxel)
Gemzar + erlotanib (Tarceva, EGFR drug)