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