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GI tract anatomy

Esophagus, stomach, small intestine, large intestine, and accessory organs.

Parts of the small intestine

Duodenum, jejunum, and ileum.

Parts of the large intestine

Cecum, colon, rectum, and anus.

Accessory organs of the GI system

Liver, gallbladder, and pancreas.

Esophageal cancer lifetime risk

1 in 125 men and 1 in 417 women.

Esophageal cancer percentage of all cancers

Approximately 1%.

Common age range for esophageal cancer diagnosis

55-85 years old.

Esophageal cancer 5-year survival rate

20%.

When is esophageal cancer usually diagnosed?

Usually at an advanced stage.

Esophageal cancer: alcohol and tobacco use

Associated with squamous cell carcinoma.

Barrett's esophagus

A condition in which the distal esophageal lining changes from stratified squamous epithelium to columnar epithelium; associated with adenocarcinoma.

What can cause Barrett's esophagus?

Years of chemical trauma from GERD.

GERD association with esophageal cancer

Approximately 30% of esophageal cancers are associated with GERD.

Other esophageal cancer risk factors

Low intake of fresh fruits and vegetables, high intake of nitrates, and overweight/obesity.

Where do most esophageal tumors occur?

Middle third of the esophagus (mid-thoracic region).

Most common symptoms of esophageal cancer

Dysphagia and weight loss; occur in approximately 90% of patients.

Dysphagia

Difficulty swallowing.

Odynophagia

Painful swallowing; occurs in approximately 50% of esophageal cancer patients.

What can patients with esophageal cancer experience when eating?

Food sticking in the throat or chest.

How long can food-sticking symptoms occur before diagnosis?

Sometimes 3-6 months.

Other esophageal cancer symptoms

Pressure or burning sensation similar to heartburn.

Advanced esophageal cancer symptoms

Hematemesis, coughing, hemoptysis, and hoarseness.

Hematemesis

Vomiting blood.

Hemoptysis

Coughing up blood.

Esophageal cancer surgical treatment

Esophagectomy.

Esophagectomy

Surgical removal of the esophagus.

Esophageal cancer chemotherapy options

Carboplatin and etoposide; 5-fluorouracil (5-FU) is also listed with chemoradiotherapy.

Esophageal cancer radiation timing

Typically given before surgery (neoadjuvant), followed by curative surgery.

Is radiation therapy commonly given alone for esophageal cancer?

Rarely.

Esophageal cancer radiation dose

Depends on whether treatment is palliative, preoperative, or for a nonsurgical patient; higher doses may be used when surgery is not possible.

Esophageal cancer dose-limiting structure

Spinal cord.

Esophagitis

Inflammation of the esophagus; usually occurs around 2 weeks into treatment.

Symptoms of radiation-induced esophagitis

Substernal pain with swallowing and sensation of food sticking.

Treatment for esophagitis

Soft, bland diet; liquid pain medications; viscous lidocaine.

How does concurrent chemotherapy affect esophagitis?

It can make esophagitis worse.

Other acute side effects of esophageal chemoradiation

Nausea, vomiting, and decreased blood counts.

Possible esophageal radiation complications depending on treatment field

Pericarditis and radiation pneumonitis.

Long-term esophageal radiation side effect

Stenosis or stricture caused by scar formation.

Esophageal cancer treatment setup

Upper Vac-Lok, wing board, Timo, knee wedge, and arms up.

Esophageal cancer simulation considerations

Possible gating, pudding-type contrast such as Esophocat, and IV contrast for lymph node involvement.

Esophageal cancer OARs

Spinal cord, trachea, lungs, and heart.

Mean age at gastric cancer diagnosis

68 years old.

Gastric cancer lifetime risk in men

1 in 95.

Gastric cancer lifetime risk in women

1 in 154.

Gastric cancer risk factors

H. pylori infection, diet, tobacco, alcohol, obesity, pernicious anemia, stomach polyps, and Epstein-Barr virus (EBV).

H. pylori

Helicobacter pylori; an infection associated with gastric cancer.

Pernicious anemia

A condition involving low red blood cell count and impaired vitamin absorption, listed as a gastric cancer risk factor in the slides.

Gastric cancer clinical presentation

Can be asymptomatic; may cause weight loss, pain, fullness, early satiety, and heartburn.

Early satiety

Feeling full after eating only a small amount of food.

Most common gastric cancer pathology

Adenocarcinoma; approximately 95% of cases.

Gastric cancer spread at diagnosis

Approximately 80-90% of tumors have already spread elsewhere at diagnosis.

Common sites of gastric cancer metastasis

Liver and lymph nodes.

Gastric cancer treatment setup

Upper Vac-Lok, wing board, Timo, knee wedge, and arms up.

Gastric cancer OARs

Kidneys, lungs, pancreas, and liver.

Pancreatic cancer percentage of all cancers in the US

Approximately 3%.

Pancreatic cancer percentage of cancer deaths in the US

Approximately 7%.

Pancreatic cancer ranking as a cause of cancer death

4th leading cause of cancer deaths in the US, according to the slides.

Pancreatic cancer lifetime risk

1 in 64.

Typical age at pancreatic cancer diagnosis

50-80 years old.

Pancreatic cancer risk from cigarette smoking

Smoking is associated with a 2-times higher risk.

Genetic risk factors for pancreatic cancer

Lynch syndrome, BRCA2 mutation, and p16.

Other pancreatic cancer risk factors

Hereditary pancreatitis, industrial chemicals, high-fat diet, red and processed meats, obesity, and diabetes mellitus.

Industrial chemicals associated with pancreatic cancer

Benzidine and beta-naphthylamine.

Pancreatic cancer clinical presentation

Jaundice, dark urine, light-colored stools, itching, abdominal pain, decreased appetite, weight loss, digestive problems, and new-onset diabetes later in life.

Jaundice

Yellowing of the skin and eyes.

Why can pancreatic cancer cause dark urine and light-colored stools?

Jaundice can be associated with dark urine and light-colored stools.

Pancreatic cancer metastases at diagnosis

Present in approximately 52% of cases.

Common pancreatic cancer spread

Lymph node involvement or direct extension into the duodenum, common bile duct, stomach, and colon.

When is pancreatic cancer considered unresectable?

When the tumor invades specific arteries or veins.

Pancreatic cancer treatment of choice

Surgery, although most tumors are unresectable.

Distal pancreatectomy

Surgical removal of the distal portion of the pancreas.

Total pancreatectomy

Surgical removal of the entire pancreas.

Whipple procedure (pancreaticoduodenectomy)

Removal of the head of the pancreas, entire duodenum, distal stomach, gallbladder, and common bile duct.

Palliative pancreatic cancer procedures

Bypass or stent placement.

Neoadjuvant pancreatic cancer treatment

Chemotherapy with or without radiation is considered standard of care because many cancers are locally advanced at diagnosis.

Possible pancreatic cancer treatment sequence

Chemotherapy first, followed by chemoradiotherapy before surgery.

Pancreatic cancer treatment approach

Multimodality treatment is considered best and provides better survival rates.

Pancreatic radiation side effects

Nausea, vomiting, diarrhea, decreased blood counts, and stomatitis.

Stomatitis

Inflammation of the mouth lining; usually associated with combined chemotherapy and radiation in the slides.

Rare long-term pancreatic radiation side effect

Renal failure.

Pancreatic cancer treatment setup

Upper Vac-Lok, wing board, Timo, possible compression belt, knee wedge, and arms up.

Pancreatic cancer OARs

Kidneys, liver, stomach, and lungs.

Colorectal cancer lifetime risk in men

1 in 23.

Colorectal cancer lifetime risk in women

1 in 25.

What percentage of colorectal cancer cases occur in people over age 55?

Approximately 90%.

Colorectal cancer ranking as a cause of cancer death

Second leading cause of cancer death in the US, according to the slides.

Colorectal cancer genetic risk factors

Familial adenomatous polyposis (FAP) and Lynch syndrome.

Family history risk for colorectal cancer

A first-degree relative with colorectal cancer or adenomatous polyps before age 60, or two first-degree relatives at any age.

Other colorectal cancer risk factors

Chronic ulcerative colitis, inflammatory bowel disease (IBD), obesity, smoking, diabetes, excessive alcohol consumption, and decreased physical activity.

Colorectal cancer dietary risk factors

High animal fat, low fiber, high red meat, and low fruit and vegetable intake.

Most common colorectal cancer symptoms

Rectal bleeding, changes in bowel habits, changes in stool caliber, pain, nausea, vomiting, and fatigue.

Rectal bleeding in colorectal cancer

Usually bright red blood in the toilet or stool; commonly present in rectal cancer.

Stool caliber change

Pencil-thin stools.

Dark or black stools

Associated with colon cancer in the slides.

Occult blood in stool

Hidden blood that cannot necessarily be seen; listed with microcytic anemia in colon cancer.

Microcytic anemia

Anemia involving small red blood cells; may be associated with occult blood loss in colon cancer.

Colorectal cancer detection and diagnosis

Physical exam, imaging, endoscopy/colonoscopy with biopsy, FOBT, Cologuard, and digital rectal exam.

FOBT

Fecal occult blood test; checks for hidden blood in the stool.

Cologuard

A stool test that can detect blood as well as mutations in the stool.

DRE

Digital rectal exam.