The ____ is a straight collapsable tube about 25cm (10inches) long that functions as a passageway through the thorax.
the esophagus begins at the base of the pharynx at the level of ____ and descends behind the _____, passing through the mediastinum.
THe esophagus penetrates the diaphragm through an opening called the _____ _____, and it is comtinous with the stomach on the abdominal side of the diaphragm.
The esophagus is inclose proximity of the ____ and the trachea and can be divided into various areas.
The cervical esophagus is about 5cm long and extends from the level of ___ to the level of ____.
C6 & T1
Below the cervical esophagus is the ____ esophagus
In addition to the cervical & thoracic divisions, the esophagus can also be broken arbitrarily into an ____ third, a ____ third, and a ____ third.
Cancers are the least common in the ____ third and most common in the ___ or ___ third of the esophagus.
least common = upper
most common= middle or lower third
The lymphatic drainage of the esophagus is unpredictable and there are a large number of widely seperated collections of lymph nodes. Drainage does not always follow a contiguous pattern; a distance of as much as 8cm of normal esophagus may be interposed between the site of gross tumor and lymphatic metastases.
When you start trying to measure where the espohageal tumor is - start counting at the ______.
Esophageal cancer is ____% of all cancer
Esophageal cancer is ____% of all cancer deaths in the US
Men are __ to __ times more affected than women.
3 to 4
African Americans are ___% more likely to get esophageal cancer than whites
The most common age of diagnosis of esophageal cancer is ___ - ___.
55 to 85
Esophageal cancer is greater in frequency in Northern ____, northern ____ and South _____.
Incidence & Etiology (Causes of Esophageal Cancer)
Alcohol & Tobacco use
What do people commonly complain of upon clinical presentaion?
Regurgitation & aspiration
vomitting up blood
spitting up blood
What are some different teset used to detect esophageal tumors
Esophageal Tumor Locations:
___ - ___ are located in the middle third
___ - ___ are located in the lower third
___ - ___ are located in the upper third
40% to 50%
10 - 25
With esophageal cancer what is the most common pathology (in upper & middle)
At the beginning of the esophagus it is squamous cell once you pass the gastroesophageal it becomes adenocarcinomas until you reach the anus
What does it mean when staging is based on extension outward
it is staged by how many layers it has invaded.`
What are the routes of spread of esophageal cancers?
Lymphatic (submuscosal spread)
What is the primary site of metastasis of esophageal cancer?
what are the main sites of metastasis of esophageal cancer?
Liver, lung, bone, adrenals & brain
What are adrenals?
Adrenals are littel glands that sit atop the kidneys
What are treatment techhniques of esophageal cancer?
surgery - if possible.
When is surgery for esophageal cancer appropriate?
when the tumor is in the middle & lower third only.
Usually reserved for small and non-metastatic lesions
What are some complications of surgery for esophageal cancers?
PE (Pulmonary Emblem blood clot)
What are the 2 most common chemotherapy drugs used for esophageal cancer?
Remember because it has submuscosal spread the fields are large
Esophageal Radaitoin Therapy:
All lesions have a ___cm margin superior and inferior and __-__cm laterally
Lesions of the ___ third are treated with a field that begins at the level of the thyroid cartilage and end at the level of the ____ to include any scv nodes, low anterior cervical and mediastinal nodes.
Lesions of the ____ third are treated with fields that include the mediastial nodes and the celiac axis
Lesions in ___ third include ther periesophageal and medistinal nodes
In esophageal radiation therapy _____ fields are used to treat the initial large fields followed by shrinking fields.
Boost fields can be done with a 3 field technique (____ and 2 posterior obliques), Obliques, Laterals or ____)
What is the patient positioning during esophageal radiation therapy?
supine with arms by side or over head
prone with arms above head
What is the esophageal radiation alone dose?
6500 cGy with offcord at 3600 - 4500 cGy
What is the esophageal radiation doses with chemotherapy?
5040 cGy with off cord at 3600 - 4500 cGy
What are the critcal structures involved when givinig radiation to the esophagus?
Lungs, heart, and spinal cord
What are side effects of radiation to the esophagus?
ulceration of the esophagus
decreased blood counts
perforation of the esophageal-treachea wall
what is the #1 side effect of radiation to esophagus?
what is pericarditis
inflammation of heart muscles
what is transverse myelitis
severed spinal cord
What is the most important digestive enzyme?
There are greater incidence in ____, ____, & ____ of stomach cancer than inthe United States
Incidence is higher in _______ americans and _____ americans
african & native
Stomach cancer is 2:1 more common in _____
What is the peak age of stomach cancer diagnosis?
50 - 70
Stomach cancer is ___% adenocarcinoma.
the other 10% include lymphoma, squamous cell and leimomyosarcoma (smooth muscle)
In stomach cancer ____% of lesions are found in the distal portion
___% in the cardiac region
___% in the greater curvature, and
__ - ___% in the entire stomach
If the entire stomach is involved it will be a ______ not an adenocarcinoma
What are some risk factors (etiology) for stomach cancer?
Diet (red meat)
Blood type (A)
Inadequate sanitation of consumable
H. pylori (bacteria than live in the stomach acid)
What are some symtoms of stomach cancer?
epigastric distress or pain
loss of appetite
nausea & vomitting
abdominal mass or bloating
stomach tumors are diagnoised on physical exam, upper gi series, ct & endoscopy
what does the work up for stomach cancer consist of?
CBC (most have anemia)
Guaiac stool test
Endoscopy with biopsy
CT scan of chest and abdomen
What is the staging system of stomach cancer?
_______ have distanct mets at diagnosis
what does anastomosis mean?
what is the 5 year survival rate of stomach cancer?
Spread patterns of stomach cancer:
greater & lesser curvature, splenic, celiac, and haptic nodes
Spread patterns of stomach cancer:
Bowel, omenta, pancreas, colon, regional nodes
spread patterns of stomach cancers:
Liver & Lung
When is surgery possible for treating stomach cancer?
when no mets is present
what are some complications of surgery for stomach cancer?
Radiatioon therapy for stomach cancer:
AP/PA - Fields extends from diaphragm to L3 including duodenal loop and regional lymph nodes
What is the curative dose for stomach cancer?
What is the Pallative dose for stomach cancer?
What is the dose for Gastric Lymphomas?
What are side effects of radiation therpay when treating stomach ca?
decreased blood counts
and transverse myelitis
what are the critcial structures to be concerned with when giving radiation therapy to the stomach ca?
What position should the patient be in for rad. therapy of the stomach?
supine with arms over head
In the small intestine cancers are rarely ______
In the small intestine tumors are usually located in the _____ or first few jujunal lesions.
___% of all small intestine lesions are adenocarcinomas
Lymphoma, carcinoids and sarcomas make up the rest
You do not treat the small intestine with radiation because the small bowel is constantly moving
Once cancer of the small intestine moves into the blood stream it normally goes straight to the ____
What are some symtoms of small intestine cancer?
N & V
change in bowel habits
Small Intestine disease can spread by direct extension, ____ or blood system to _____, lungs and bone
_____ ______ disorders include polyposis, Crohn disease, and Gardner's syndrome
What are treatment options for small intestine disease?
Chemotherapy ( 5 FU )
with no role for radiation therapy due to the bowel sensitivity and motion of the organ
what is the 5 year survival rate for small intestine?
less than 20%
Large intestine cancer is ranked ____ in the US for men & women in incidence and ____ for overall death rates
peak age for large intestine diagnosis is ____ or older
_______ lesions are most common in large intestine cancer
causes of large intestine cancer are:
diets high in fat
diets low in fiber
minimal physical activity
chronic ulcerative colitis
What is the # 1 symptom of large intestine cancer?
blood in stool
Define tenesmus. (large Intestine)
What are some symptoms of Large Intestine Cancer?
Blood in stool
rectal bleeding (hematochezia)
Change in bowel habits
tenesmus (rectal spasms)
N & V
How is large intestine cancer detected & diagnosed?
radiographic & endoscopic studies
How is staging done for Large Intestine Cancer?
TNM classification or the Dukes classification (A, B,C)
All staging classifications are explaining the penetration of the tumor through the layers of the bowel wall
What are some of the routes of spread in Large Intestine Cancer?
Direct extension (penetrates bowel wall, not longitudinally like esophagus)
Lymphatic (if tumor has penetrated the submucosal layer)
This will be in an orderly fashion starting with the