Medicine an Surgery notes

Apr 24th, 2015
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0DIAGNOSIS AND MANAGEMENT ESOPHAGEAL CANCERIntroduction, definition, age, pathology -Refer.SexM:F - 25:1AgeAverage age - 58.2yrs (12-103yrs)Prevalent region - Central Nyanza province Predisposing factors Contribute to repeated long term minimal traumaa)Lifestyle1.Smoking - SCC2.Alcohol excess - SCC-Betel chewingb).Diet3-Hot foods4-Deficiency of antioxidants which have been found to inhibit carcinogenesis, including selenium, vitamins C and E, retinoids, & ?-carotene, & plant sterols.5-Exposure to N-nitroso compounds (from Nitrates & Nitrites converted by bacteria in the body) 6-Charred meat, Smoked fishC)Disorders of esophagus7.Achalasia8.Long standing oesophageal strictures9.Post-irradiation10.Paterson-Brown-Kelly (Plummer-Vinson) Syndrome - Post cricoid web + IDA11.Barrett's oesophagus - there is a 44-fold ? risk of Adenocarcinoma if severe reflux for >10yrsd)Genetics12.Tylosis (Palmar hyperkeratosis)13.Coeliac disease - Predisposes to Adenocarcinomas14-Epidrmolysis bullosa15-P53 and RB genesPathologyTypes;Squamous cell carcinoma- Most common worldwideAdenocarcinoma - Most common in most Westernised countriesOat cell carcinomaSite;20% - Upper ? - Squamous cell carcinoma50% - Middle ? - Squamous cell carcinoma30% - Lower ? - AdenocarcinomaSpread;1. Local-regional - Occurs through submucosal infiltration of the wall of the oesophagus into adjacent structures, along the length of the oesophagus in the submucosal lymphatics & to region

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