diagnostic de cancers de l’oesophage et de l’estomac dr denis li kam wa gastro enterologue

DIAGNOSTIC DE CANCERS DE L’OESOPHAGE ET DE

L’ESTOMACDr Denis LI KAM WA

Gastro enterologue

FACTEURS DE RISQUE

• 1.1.AGE ET SEXE• 1.2.PRIVATION• 1.3. TABAC• 1.4.ALCOOL• 1.5. BMI• 1.6.DIET• 1.7.GENETIC• 1.8.PREDISPOSITIONS• 1.9.HP

SYMPTOMES

• 1.DYSPEPSIES

• 2.REFLUX GASTRO OESOPHAGIEN

• 3. SIGNES D’ALARMES

DELAIS AU DIAGNOSTIC

• 1.DUREE DES SYMPTOMES

• 2.DELAI DES PATIENTS

• 3.DELAI DES MEDECINS

• 4.LISTE D’ATTENTE A L’HOPITAL

DIAGNOSTIC

• 1. PLACE DE TRANSIT OESOGASTRODUODENAL

• 2.GASTROSCOPIE

• 3.CHROMOENDOSCOPIE

HISTOLOGIE

• BIOPSIES ENDOSCOPIQUES

• HISTOPATH

STAGING

• CLASSIFICATION TNM:

• TECHNIQUES:

• CT SCAN

• ECHOENDOSCOPIE

• LAPAROSCOPIE

• IRM

• BRONCHOSCOPIE,POSITRONS?

CANCERS COLO RECTAL

• FREQUENCE:

FACTEURS PREDISPOSANTS

• 95% SONT SPORADIQUES

• AGE: A PARTIR DE 50 ANS

• ADENOMES:TAILLE,VILLEUSE,DYSPLASIE

• FAMILIAL: 5%

• LESIONS INFLAMMATOIRES CHRONIQUES:RCH,CROHN

DEPISTAGE

• SANG OCCULTE

• COLOSCOPIE

• SIGMOIDOSCOPIE

• COLOSCOPIE VIRTUEL: CT SCAN,IRM

DIAGNOSTIC:SYMPTOMES

• TRES LONGTEMPS ASYMPTOMATIQUES

• ANEMIE FERRIPRIVE• MELAENAS,RECTORRAGIES,

ALTERATION DU TRANSIT• ALTERATION DE L’ETAT GENERAL• T ABDOMINAL,FOIE METASTATIQUE• COMPLICATION:OCCLUSION,

PERFORATION

EXPLORATIONS COMPLEMENTAIRES

• ECHOENDOSCOPIE

• SCANNER,OU IRM

• RECHERCHE DE METASTASES:CT SCAN THORACO ABDOMINO PELVIENNES,RX PULMONAIRE, ECHO ABDO

Gastro-intestinal Malignanacies in Mauritius

New Cases Diagnosed during period 2001 - 2005

Cancer Site Male FemaleOesophagus 80 44

Stomach 187 109Small Intestine 11 18Colon 171 164Rectum 169 120Anus 12 11

Liver & Intra-hepatic bile ducts57 57Gall bladder, etc 30 69

Pancreas 12 31Digestive Organs 729 623

By comparison:

Female Breast 0 1348

Uterine Cervix 0 477

All Sites 2812 3935

Source: National Cancer Registry of Mauritius

Case study

• A 47 year old male with HBP comes to clinic for routine check . His father had CA colon at 56 , his parental grand mother died of cancer, but he is not sure of what type at 49, but it is not colon,female organ cancer? He is afraid of prostate cancer.

At what age to do systematic screening for colon?

• 40 years

• 45 years

• 50 years

• 55 years

• 60 years

Which is commonly accepted modifiable risk factor with increased

risk of colorectal cancer• A) alcohol consumption

• B) obesity

• C) physical inactivity

• D) all

Screening decrease incidence of colonic cancer

• True or false

• What type of screening ;

• Virtual colonoscopy?

• Coloscopy?

• Sigmoidoscopy?

• Fob?

What factor indicate that screening for colorectal cancer may be

necessary?• A) 1st degree relative with diagnosis of

colon cancer before 60.

• B) history of HBP

• C) possibility of grand mother with endometrial cancer

• D) both A and C

Which major risk should be noted when evaluating a patient for early

colorectal cancer screening?• A) family history breast cancer

• B) chronic inflammatory bowel disease

• C) onset of early menses in females

• D) none of the above

SUMMARY

• A) colorectal cancer is 2nd leading cause of cancer mortality

• B) can be reduced by screening

• C) most patients with colorectal cancer have no known risk factors

• D) occult gi bleeding is intermittent so once a patient is + ,no need for repeat

• E) stool testing at home