by Dr Denis Li Kam Wah

publicité
DIAGNOSTIC DE CANCERS DE
L’OESOPHAGE ET DE
L’ESTOMAC
Dr Denis LI KAM WA
Gastro enterologue
FACTEURS DE RISQUE
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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
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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
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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,DYSPLA
SIE
• FAMILIAL: 5%
• LESIONS INFLAMMATOIRES
CHRONIQUES:RCH,CROHN
DEPISTAGE
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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
New Cases Diagnosed during period 2001 - 2005
Cancer Site
Male
Oesophagus
80
Stomach 187
109
Small Intestine 11
Colon
171 164
Rectum
169 120
Anus
12
Liver & Intra-hepatic bile ducts57
Gall bladder, etc
30
Pancreas 12
31
Digestive Organs 729
Female
44
18
11
57
69
623
By comparison:
Female Breast
0
1348
Uterine Cervix
0
477
All Sites 2812
3935
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?
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40 years
45 years
50 years
55 years
60 years
Which is commonly accepted
modifiable risk factor with
increased risk of colorectal cancer
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A) alcohol consumption
B) obesity
C) physical inactivity
D) all
Screening decrease incidence of
colonic cancer
• True or false
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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?
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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
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