GI System - Surgery - Pr Bennami

What percentage of all digestive cancers does esophageal cancer represent?

13%

Which gender is predominantly affected by esophageal cancer?

Men

What two main histological types of esophageal cancer exist?

Squamous cell carcinoma (SCC) and Adenocarcinoma (AC)

Which type of esophageal cancer is most frequent globally?

Squamous cell carcinoma (SCC)

Which type of esophageal cancer is more common in Western countries?

Adenocarcinoma (AC)

What percentage of patients are candidates for surgery?

~30%

What is the 5-year survival rate for esophageal cancer?

5–10%

How long is the esophagus from the dental arches?

25–40 cm

Into how many parts is the esophagus divided?

Three: cervical, thoracic, abdominal

Through which mediastinum does the esophagus pass?

Posterior mediastinum

Which layer of the esophagus contains nonkeratinized stratified squamous epithelium?

Mucosa

Which layer contains Meissner’s plexus?

Submucosa

Which part of the muscularis externa is striated?

Upper 1/3

Which part of the muscularis externa is smooth muscle?

Middle/lower 2/3

Which arteries supply the cervical esophagus?

Inferior thyroid artery

Which arteries supply the thoracic esophagus?

Bronchial arteries and aorta

Which arteries supply the abdominal esophagus?

Left gastric and inferior phrenic arteries

How long does a solid bolus take to pass through the esophagus?

4–8 sec

How long does a liquid bolus take to pass through the esophagus?

~1 sec

What ensures entry of the bolus into the stomach?

Coordinated sphincter relaxation

What is the global incidence of esophageal cancer?

3–6 per 100,000

Where does esophageal cancer rank in common cancers worldwide?

8th most common

Where does esophageal cancer rank as a cause of cancer death?

6th leading cause

Which geographical regions are hotspots for esophageal cancer?

Northern China, Japan

What is the male-to-female ratio in esophageal cancer?

7:1

At what age is esophageal cancer usually diagnosed?

60–70 years

What percentage of esophageal cancers are SCC?

80%

What percentage of esophageal cancers are AC?

20%

Name key risk factors for SCC.

Alcohol, tobacco, dietary nitrosamines, hot beverages, genetic predisposition, precancerous conditions

Which genetic conditions predispose to SCC?

MEN1, Fanconi anemia

Name precancerous conditions associated with SCC.

Plummer-Vinson syndrome, caustic injury, achalasia

What percentage of SCC cases are associated with head and neck cancers?

12–17%

What is the main pathway for AC development?

Chronic GERD

Name other risk factors for AC.

Obesity, male sex, Caucasian race, diets high in meat, low in fruits/vegetables

Where is esophageal cancer predominantly located macroscopically?

Lower third

How does SCC typically spread microscopically?

Extensive local growth, early nodal invasion

How does AC typically spread microscopically?

Less local invasion, widespread metastases (skip lesions)

What is Barrett’s esophagus?

Intestinal metaplasia due to chronic reflux

What does the TNM classification outline?

Tumor invasion (T), nodal involvement (N), metastasis (M)

What is the typical progression of dysphagia in esophageal cancer?

Solids to liquids

Name three common symptoms of esophageal cancer.

Weight loss, anorexia, chest pain

What symptoms appear in advanced cases?

Odynophagia, vomiting, GI bleeding, dyspnea

What are typical physical examination findings in early esophageal cancer?

Often normal

What physical findings indicate advanced disease?

Cervical lymphadenopathy, hepatomegaly, signs of metastases

Name two paraneoplastic signs associated with esophageal cancer.

Leser-Trélat sign, acanthosis nigricans

What are loco-regional effects of esophageal cancer on nerves?

Dysphonia, aspiration

What symptom indicates an esotracheal fistula?

Cough with swallowing

What is the first-line diagnostic test for esophageal cancer?

Upper GI endoscopy with biopsy

Which imaging technique is useful in severe stenosis?

Barium swallow

Which imaging methods are used for staging and metastasis evaluation?

CT, PET/CT

Which procedure assesses depth and nodal involvement?

Endoscopic ultrasound

When are bronchoscopy and ENT evaluation indicated?

If proximal tumor or airway invasion suspected

What aspects are evaluated in the post-diagnosis workup of esophageal cancer?

Disease (TNM, locoregional, distant) and patient status (nutrition, cardiopulmonary, renal, liver function)

Who is involved in planning post-diagnosis management?

Multidisciplinary team

Name criteria that make esophageal cancer non-resectable.

T4, M1 tumors, severe comorbidities, advanced age, significant weight loss

What is the main curative treatment for esophageal cancer?

Surgery

When is chemoradiotherapy used in curative treatment?

As neoadjuvant or definitive treatment

Name three surgical approaches for subtotal esophagectomy.

Lewis-Santy, Akiyama, transhiatal

What additional procedure is performed during surgical esophagectomy?

Lymphadenectomy

Name endoscopic therapies for early-stage esophageal lesions.

Mucosectomy, endoscopic resection, stenting

How is radiotherapy used for SCC?

Curative

How is radiotherapy used for AC?

Neoadjuvant or concurrent with chemotherapy

Name palliative care options for esophageal cancer.

Chemotherapy, stenting, bypass surgery, enteral feeding, symptomatic management

How often should patients be followed up after curative treatment in the first 3 years?

Every 3–6 months

What does follow-up include?

History, exam, imaging (CT), tumor markers, endoscopy (if no resection), nutritional assessment

What is the 5-year survival rate for localized esophageal cancer?

47%

What is the 5-year survival rate for regional esophageal cancer?

25%

What is the 5-year survival rate for metastatic esophageal cancer?

5%

How does R0 resection affect survival?

Improves survival to 25–40%

How does R1 resection affect survival?

Less than 5%

What is the recurrence risk by 46 months?

~38%

What is the recurrence risk by 6 years?

50%

What is the rate of surgical complications?

Up to 75%

Name common surgical complications.

Anastomotic leaks, strictures, pneumonia

Name radiotherapy toxicities.

Esophagitis, dysphagia, nausea, late strictures, organ-specific toxicity

What are the typical presenting symptoms of esophageal cancer?

Progressive dysphagia, weight loss

Why does esophageal cancer extend rapidly?

Lack of serosa and early lymphatic spread

Which histology is most common worldwide?

SCC

Which histology is prevalent in Western countries?

AC

Name key risk factors for SCC.

Alcohol, tobacco

Name key risk factors for AC.

Barrett’s esophagus, GERD

What is the gold standard for diagnosis?

EGD with biopsy

What is required for staging?

Imaging

What does management of esophageal cancer require?

Multidisciplinary care combining surgery, chemoradiotherapy, and supportive care

Why is overall prognosis poor?

Late presentation and high recurrence risk

What is stomach cancer?

Neoplastic disease originating in the gastric wall, excluding the cardia

What type of cancer represents over 95% of gastric cancers?

Adenocarcinoma

Name some rarer types of gastric cancer.

Stromal tumors, lymphomas, neuroendocrine tumors, metastases

How common is gastric cancer in Morocco among digestive cancers?

Second most common

Why does gastric cancer often have a poor prognosis?

Often diagnosed late

What is the primary treatment for gastric cancer?

Surgical

Where is the stomach located?

Left upper abdomen, mainly epigastric region

What is the proximal boundary of the stomach?

Gastroesophageal junction (GEJ)

What is the distal boundary of the stomach?

Pyloric sphincter

Name the anatomical regions of the stomach.

Cardia, fundus, body, pylorus

What is the significance of the cardia region?

Important in adenocarcinoma classification (Siewert system)

What structure connects the lesser curvature of the stomach to the liver?

Lesser omentum

What structure connects the greater curvature to the transverse colon?

Greater omentum

Name the histological layers of the stomach.

Mucosa, submucosa, muscularis propria, serosa

From which artery does the stomach receive its blood supply?

Celiac artery