For more information, visit https://www.timberlandmedical.com This presentation is by Dr. Wong Kwong Hieng (MBBch,FRCS,AM) General Surgeon at Timberland Medical Centre. Timberland Medical Centre is a private hospital that has been in operation since 1994. We are strategically located at the 3rd Mile roundabout on Jalan Rock, Kuching, Sarawak, East Malaysia. Our hospital is 10 minutes from the Kuching International Airport and 15 minutes from the Central Bus Terminal. We continually seek to improve and upgrade our services and facilities, as we strive to provide the best medical care for our patients and customers.

1. CANCER OFCANCER OF
OESOPHAGUS ANDOESOPHAGUS AND
STOMACHSTOMACHSTOMACHSTOMACH
By:By:By:By:
Dr. Wong Kwong HiengDr. Wong Kwong Hieng
(MBBch,FRCS,AM)(MBBch,FRCS,AM)
General SurgeonGeneral SurgeonGeneral SurgeonGeneral Surgeon
TIMBERLAND MEDICAL CENTRETIMBERLAND MEDICAL CENTRE

2. DIGESTIVE SYSTEMDIGESTIVE SYSTEM

4. CANCER OF OESOPHAGUSCANCER OF OESOPHAGUSCANCER OF OESOPHAGUSCANCER OF OESOPHAGUS
EPIDEMIOLOGYEPIDEMIOLOGYEPIDEMIOLOGYEPIDEMIOLOGY
Oesophageal cancer is a relatively rare form ofOesophageal cancer is a relatively rare form of
cancer.cancer.
As an example in USA approximately 16,000 newAs an example in USA approximately 16,000 new
oesophageal cancer cases are diagnosed yearlyoesophageal cancer cases are diagnosed yearly
( out of population of 300 millions).( out of population of 300 millions).
However, higher incidence is noted in China, India,However, higher incidence is noted in China, India,
Japan and UK and in AfricanJapan and UK and in African--American.American.pp

5. CLASSIFICATIONCLASSIFICATIONCLASSIFICATIONCLASSIFICATION
According to the anatomy of the oesophagus there areAccording to the anatomy of the oesophagus there areAccording to the anatomy of the oesophagus, there areAccording to the anatomy of the oesophagus, there are
essentially two types of cancer of oesophagus.essentially two types of cancer of oesophagus.
Squamous cell carcinomaSquamous cell carcinoma -- in the upper 2/3 of oesophagusin the upper 2/3 of oesophagus
related to head & neck cancer and associated withrelated to head & neck cancer and associated with
smoking and alcohol consumption.smoking and alcohol consumption.
AdenocarcinomaAdenocarcinoma –– in the lower 1/3 ofin the lower 1/3 of
oesophagus related to gastroesopahgealoesophagus related to gastroesopahgeal
reflux disease and Barrett’s oesophagusreflux disease and Barrett’s oesophagus

6. MALIGNANT TUMORS OF THEMALIGNANT TUMORS OF THE
OESOPHAGUSOESOPHAGUS
Image 1Image 1 Image 2Image 2

7. OesophagusOesophagus Normal OesophagusNormal Oesophagusp gp g p gp g
Esophageal CancerEsophageal Cancer

8. SIGNS AND SYMPTONSSIGNS AND SYMPTONSSIGNS AND SYMPTONSSIGNS AND SYMPTONS
Dysphagia (Difficulty in swallowing)Dysphagia (Difficulty in swallowing)
Odynophagia (Painful swallowing)Odynophagia (Painful swallowing)Odynophagia (Painful swallowing)Odynophagia (Painful swallowing)
Weight LossWeight Loss
VomitingVomiting
HaematemesisHaematemesisHaematemesisHaematemesis
MetastasesMetastases

9. CAUSES AND RISK FACTORSCAUSES AND RISK FACTORSCAUSES AND RISK FACTORSCAUSES AND RISK FACTORS
AgeAgegg
GenderGender
HeredityHeredityHeredityHeredity
Smoking and heavy alcoholSmoking and heavy alcohol
Diet (caustic substances, nitrosamine,Diet (caustic substances, nitrosamine,
preserved and smoked)preserved and smoked)p )p )
Radiation therapyRadiation therapy
Gastroesophageal reflux disease andGastroesophageal reflux disease andGastroesophageal reflux disease andGastroesophageal reflux disease and
Barrett’s oesophagus.Barrett’s oesophagus.
OOObesityObesity

10. DIAGNOSISDIAGNOSISDIAGNOSISDIAGNOSIS
Best made with Endoscopy and biopsyBest made with Endoscopy and biopsyes ade doscopy a d b opsyes ade doscopy a d b opsy
XX--ray (Barium swallow) and CT scanray (Barium swallow) and CT scan

11. TREATMENTTREATMENTTREATMENTTREATMENT
SSSurgerySurgery
ChemotherapyChemotherapypypy
RadiotherapyRadiotherapy
Laser therapyLaser therapyLaser therapyLaser therapy
Neoadjuvant chemoradiationNeoadjuvant chemoradiation
StentingStenting
Surgery difficult due to anatomy andSurgery difficult due to anatomy and
accessibility compared to stomach canceraccessibility compared to stomach canceraccessibility compared to stomach cancer.accessibility compared to stomach cancer.

12. Shows cancer blockingShows cancer blocking
esophagus Insets showesophagus Insets showesophagus. Insets showesophagus. Insets show
enlarged area of cancerenlarged area of cancer
and a stent placed in theand a stent placed in theand a stent placed in theand a stent placed in the
esophagus to keep itesophagus to keep it
open.open.pp
SelfSelf--expandableexpandable
t lli t tt lli t tmetallic stents aremetallic stents are
used for theused for the
lli ti flli ti fpalliation ofpalliation of
esophageal canceresophageal cancer

13. FOLLOWFOLLOW UP AND PROGNOSISUP AND PROGNOSISFOLLOWFOLLOW--UP AND PROGNOSISUP AND PROGNOSIS
Poor , 5 year survival less than 25%Poor , 5 year survival less than 25%, y, y

14. CANCER OF STOMACHCANCER OF STOMACHCANCER OF STOMACHCANCER OF STOMACH
EPIDEMIOLOGYEPIDEMIOLOGYEPIDEMIOLOGYEPIDEMIOLOGY
Stomach cancer is a more common cancer thanStomach cancer is a more common cancer than
oesophageal canceroesophageal canceroesophageal cancer.oesophageal cancer.
In USA about 26 000 new cases of stomachIn USA about 26 000 new cases of stomachIn USA about 26,000 new cases of stomachIn USA about 26,000 new cases of stomach
cancer are diagnosed each year. Roughlycancer are diagnosed each year. Roughly
representing 2% of all new cancer cases eachrepresenting 2% of all new cancer cases each
year.year.
However, it is much more common in Korea,However, it is much more common in Korea,
Japan, UK, South America and Iceland.Japan, UK, South America and Iceland.

15. CLASSIFICATIONCLASSIFICATIONCLASSIFICATIONCLASSIFICATION
Mostly adenocarcinoma (epithelial tumour)Mostly adenocarcinoma (epithelial tumour)y ( p )y ( p )
L hL hLymphomaLymphoma
Linitus PlasticaLinitus Plastica
(l th(l th b ttl t h)b ttl t h)(leather(leather--bottle stomach)bottle stomach)
scirrhous carcinoma.scirrhous carcinoma.scirrhous carcinoma.scirrhous carcinoma.

16. NORMAL IMAGES OF THENORMAL IMAGES OF THE
STOMACHSTOMACH
Image 1Image 1 Image 2Image 2Image 1Image 1
Image 3Image 3

17. MALIGNANT TUMORSMALIGNANT TUMORS
OF THE STOMACHOF THE STOMACH
Image 1Image 1 Image 2Image 2Image 1Image 1 Image 2Image 2
Stomach CancerStomach Cancer

18. SIGNS AND SYMPTOMSSIGNS AND SYMPTOMSSIGNS AND SYMPTOMSSIGNS AND SYMPTOMS
EARLYEARLY LATELATE
Often asymptomatic or nonOften asymptomatic or non--
specific in early stagesspecific in early stages
(delayed diagnosis)(delayed diagnosis)
Abdominal PainAbdominal Pain
Nausea & VomitingNausea & Vomiting
(delayed diagnosis)(delayed diagnosis)
Indigestion / HeartburnIndigestion / Heartburn
Diarrhoea & constipationDiarrhoea & constipation
Bloating after mealsBloating after meals
Indigestion / HeartburnIndigestion / Heartburn
L f titL f tit
Weight LossWeight Loss
WeaknessWeakness
Loss of appetiteLoss of appetite Bleeding & AnaemiaBleeding & Anaemia

19. CAUSES AND RISK FACTORS(1)CAUSES AND RISK FACTORS(1)CAUSES AND RISK FACTORS(1)CAUSES AND RISK FACTORS(1)
AgeAge
GenderGenderGenderGender
Heredity / GeneticHeredity / Genetic
High Salt DietHigh Salt Diet
SmokingSmokingSmokingSmoking
Lack of fruits / veggieLack of fruits / veggie
H.Pylori infection (80%) associated withH.Pylori infection (80%) associated with
gastritis and intestinal metaplasiagastritis and intestinal metaplasiagastritis and intestinal metaplasiagastritis and intestinal metaplasia

20. HELICOBACTER PYLORIHELICOBACTER PYLORIHELICOBACTER PYLORIHELICOBACTER PYLORI

21. CAUSES AND RISK FACTORS(2)CAUSES AND RISK FACTORS(2)CAUSES AND RISK FACTORS(2)CAUSES AND RISK FACTORS(2)
Korea and Japan have very high incidence ofKorea and Japan have very high incidence of
stomach cancer. In Korea 21% of cancers arestomach cancer. In Korea 21% of cancers are
from stomach (compared with 2% in USA) and itfrom stomach (compared with 2% in USA) and it
is the second leading cause of cancer deaths.is the second leading cause of cancer deaths.
(In Malaysia leading causes of cancer deaths(In Malaysia leading causes of cancer deaths
are lung, breast, colon, ovarian /uterine,are lung, breast, colon, ovarian /uterine,
nasopharyngeal, liver, stomach, oesophagus).nasopharyngeal, liver, stomach, oesophagus).
A Korean diet high in salt content (pickledA Korean diet high in salt content (pickled
chinese cabbage known as Kimchi) is thought tochinese cabbage known as Kimchi) is thought to
be a contributing factor.be a contributing factor.

22. DIAGNOSISDIAGNOSISDIAGNOSISDIAGNOSIS
Endoscopy and biopsyEndoscopy and biopsy
XX--ray (barium meal)ray (barium meal)XX ray (barium meal)ray (barium meal)
Blood and Stool TestsBlood and Stool Tests
(Tumour marker e.g. CA 19.9, CEA, FOB)(Tumour marker e.g. CA 19.9, CEA, FOB)
CT ScanCT ScanCT ScanCT Scan

23. GASTROSCOPY (ENDOSCOPY)GASTROSCOPY (ENDOSCOPY)( )( )

24. TREATMENTTREATMENTTREATMENTTREATMENT
SurgerySurgery
ChemotherapyChemotherapy
RadiotherapyRadiotherapyRadiotherapyRadiotherapy

25. FOLLOWFOLLOW UP AND PROGNOSISUP AND PROGNOSISFOLLOWFOLLOW--UP AND PROGNOSISUP AND PROGNOSIS
Early diagnosis and surgery offers bestEarly diagnosis and surgery offers best
chance of curechance of cure
Oft L t di i l di t 80% fOft L t di i l di t 80% fOften Late diagnosis leading to 80% ofOften Late diagnosis leading to 80% of
cases with metastasis at presentation.cases with metastasis at presentation.
5 ear s r i al rate from 30% to 75%5 ear s r i al rate from 30% to 75%5 year survival rate from 30% to 75%5 year survival rate from 30% to 75%

26. THANK YOUTHANK YOUTHANK YOUTHANK YOU
FORFORFORFOR
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