tailieunhanh - Sách: MANAGEMENT OF OESOPHAGEAL AND GASTRIC CANCER

In a study of potential bone marrow transplant recipients, patients reported an improved outlook on life, enhanced relationships, and greater satisfaction with religious concerns (Andrykowski et al., 1993). The authors note that cancer should not be viewed as a homo- geneously negative event, but as a “psychosocial transition, . an event with significant negative implications that can nevertheless cause individuals to restructure their attitudes, values, and behaviors, and thus can serve to trigger positive psychosocial change” (p. 274). It is important to note that these findings should not obscure the fact that the expe- rience of breast cancer remains a major stressor (Carver et al., 1993). And. | SIGN Scottish Intercollegiate Guidelines Network NHS Quality Improvement Scotland Management of oesophageal 87 and gastric cancer Quick Reference Guide June 2006 COPIES OF ALL SIGN GUIDELINES ARE AVAILABLE ONLINE AT PRESENTATION AND REFERRAL RISK FACTORS Oesophageal and gastric cancers occur mainly in people over 55 years of age. Male sex is a risk factor for squamous cancer of the oesophagus and for oesophagogastric junction cancer. Deprivation is a risk factor for development of squamous cancer of the oesophagus and for gastric cancer. Tobacco smoking increases the risk of squamous cancer of the oesophagus approximately nine fold compared with age and sex matched controls. Squamous cancer of the oesophagus and gastric cancer are associated with alcohol consumption. Increasing body mass index BMI is associated with an enhanced risk of oesophageal adenocarcinoma and with a risk of oesophagogastric junction cancer. The presence of Helicobacter pylori infection is associated with a two to threefold increase in the risk of developing gastric cancer. B A test and treat policy for Helicobacter pylori should be employed in the initial management of patients with uncomplicated dyspepsia. C Irrespective of age patients should be reviewed after Helicobacter pylori eradication treatment. For those with recurrent or persistent symptoms the need for further assessment including endoscopy should be considered. In patients with gastro-oesophageal reflux symptoms endoscopy with the intention of identifying cancer is not indicated unless an alarm symptom is also present. Alarm symptoms B Patients presenting with any of the following alarm symptoms should be referred for early endoscopy dysphagia recurrent vomiting anorexia weight loss gastrointestinal blood loss. 0 Prompt investigation and assessment of patients referred with symptoms suggestive of oesophageal or gastric cancer are desirable in order to minimise the period of anxiety and uncertainty about diagnosis