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Hello, everyone. I hope you're all doing well. My name is Rashida and I'm one of the chair at welcome to the sixth week of our teaching series. This week we are focusing on upper gi surgery and we're very happy to have you all here with us today. Today, I'm joined by Henry who will guide you through upper gi cancers. Henry is 1/4 year from the Bright Sussex Medical School to make the session as engaging as possible. We'll be releasing both throughout the session. These are completely anonymous. So we encourage you to participate actively. If you have any questions during the session, please pop them in the chart and we'll address them at the end of the session. We'll also share a feedback form at the end. If you complete this, you'll receive a certificate of attendance and exclusive discount codes to teach me surgery and pass the MRC S. This session is being recorded and the recording and the slides will be shared on a me page as well as a website a couple of hours after the session. So be sure to keep an eye out for that. As you may know, we have launched our very own learning portal which is hosted on our website through this learning portal. You'll get access to practice questions, session recordings and your vision material. As a bonus, all members will get a discount code to get 10% off the GKI Metics and naturally flashcards, surgical flashcards and knowledge bundle membership is completely free. So be sure to head on to our website after the session to expel this. We also have an exciting opportunity for all of our attendees. Tell people will win free access to the kiki metics, surgical flashcards and the Kiki metics ay stations to enter simply complete the Google form at the end of the session and enter the unique code. We will provide the more sessions you attend live, the higher the chances of winning. So be sure to stay until the end of today's session and attend as many of our other sessions. Finally, before we begin, we'd like to thank our partners, the Royal College of Surgeons England, Kiki Medics, the MDU Morgan Skin, Deep Metal T three surgery and P MRC S. Without further ado, I'll now hand it over to Henry. Hi guys, I'm Henry Smid. Um As you see, um Thank you very much for the introduction. Um So today I'm gonna be talking about upper gi cancers. Um There's a lot to go through here today. So I hope you are all happy to stick with me. Um Here's a couple of L learning objectives. Um So that further do, let's get on to it. So let's start with the anatomy of the upper gi tract. Um I don't really have to go through it as in much detail. Um As you guys should probably notice at this stage, um I've put a little query in the corners saying Sad Hooker. Um Does anyone know what this might be? Um If there's anyone putting on the chart and I hope you all know that it's all the retrosternal uh retroperitoneal organs. So that's the supraadrenal. Um the aorta, the duodenum, the pancreas, uh the ureter is the colon, the kidney, the esophagus and the rectum. Now we're going onto the anatomy of the esophagus. So you could just broken it down to the cervical thoracic and abdominal parts. Um And now we're gonna talk about the blood supply to the esophagus. So the cervical esophagus. So we'll talk about this upper part here. We're gonna be supplied by the inferior a a inferior thyroid arteries. So these arteries here coming off from the subclavian. Um Then the thoracic art uh esophagus here in the middle is gonna be supplied by the thoracic aorta and the bronchial arteries. Then the oop esophagus, which bing into your gastric part is gonna be supplied by the left gastric artery and similar with the venous drainage. He's got the cervical esophagus, which can be drained by the inferior fired arch veins which are here again, coming off the fire called um the thoracic esophagus, which are draining into the esophagal vein off esophageal veins and then the abdominal eso esophagus, which is gonna be draining into the left gastric and then someone with a lymph lymph drainage. So it's really important when we think where, where these cancers might be metastasizing, especially esophageal cancers. Um So you've got the cervical esophagus, which should be gonna be draining into the deeper cervial lymph nodes, nephrotic esophagus, which should be draining into the posterior mediastinal lymph nodes and abdominal esophagus down here. It could be draining into the left gastric lymph nodes. Um And some, some places we would be thinking of where it's most likely to of esophageal cancers spread and metastasize would probably be thinking that especially if the, if it's down in the lower abdomen, we're gonna be thinking it be draining into the liver and then superiorly maybe into the lungs as well. So, I've been also been asked to discuss the stages of swallowing. So these are broken down into three phases of the oral phase, which is a voluntary phase. The pharyngeal phase was in involuntary and esophageal phase again, which is involuntary. And so, so you'll be in your voluntary phase, you're gonna be eating your food, food's gonna be hitting your hard palate, which is here at the back of your mouth. Um And then this is gonna trigger your hypoglossal nerve to enact swallowing. Then the Bolus bolus gonna enter the oropharynx, which is back here just behind your tongue. Um And it's gonna trigger the swallow reflex. It's really important that you're gonna be closing off your epiglottis here. Um And this is done by cranial nerve 10 as well. And then the i involuntary phase in the esophageal phase. So, going down the esophagus into your stomach, um the esophageal sphincter is gonna relax and the bull is gonna enter the esophagus and then through primary per peristalsis, this bolus is gonna be pushed down. And then second, we put peristalsis, it's gonna occur if any remaining food is there next, moving on to the histology of the esophagus. So this is very important when we're thinking about which cancers are and which part of the esophagus. And why? So the upper is primarily made of or entirely made of skeletal muscle. Um The middle is made of mixed, smooth and sle of muscle and then in the lower extremities are made of entirely smooth muscle, ready portions. So now I'm moving on to the cancer locations and the types of seeing in each part. So the upper third, like we said, we were talking about this smooth skeletal muscle, we're gonna see them. These are gonna probably differentiate into squamous cell carcinomas. Then middle food is a mixture of both, but we mostly will see squamous cell carcinomas. And then again, in the lower third because you've got those that muscular um glandular cells, we're gonna see adenocarcinoma. Next, moving on to the classic tumor, classic classifications. So this is a really important one. We're thinking about how to manage certain ca er cancers. So we're going, thinking about the tumor death as a team, the N for lymph node involvement and the M for distance metas metastases. And this is broken down into quite an extensive list of different types of teas. So you've got the TS where it's very small. Um The cancer's not really invading any of the further tissues. Got T two, which is invading the muscular propria propria, which is that f muscular tissue really. And T three is the adventitia and then the four is moving on to ad adjacent structures and the nodes we're seeing N zero has got no low lymph node metastases N 11 or two and 236 and then three greater than seven. And the metastases are either present or not present. And again, when we're talking about esophageal cancer, we're talking usually the liver. Um So I think we'll move on to our first poll question today. I don't know if you guys can see that poll question. So you just had some responses. 85% have gone with the liver and 12% have gone with the baritone. Yeah. Yeah. You'd be absolutely right. If you're going for the liver, like I said before, um it's the most common site of draining from necessities for esophageal cancers. Um It's got a rich vascular supply. And we're thinking about especially in, in the lower esophagus. When you're eating that food, it's gonna be going into the portal veins and it be draining into the liver. Um, other common sites, like I said, are the lungs, uh, bones and also interesting enough adrenal glands, but the liver is the most, er, commonplace. Then we're looking at risk factors. So these can be split into, as I say, with the two different types of cancers and the two different parts of the body, two different parts of the esophagus. We're gonna be seeing there. So we've got squamous cell carcinomas and there are different risk factors. We see for that adenocarcinoma and the different types of risk factors will be seen for those types of cancers. Um, so again, this is just the cervical part and the thoracic part, we mainly we're gonna be looking at for squamous cell carcinoma and we were seeing smoking as you can imagine smoking, breathing in that hot air, all the tobacco in the tar damaging all your esophagus, esophagus as well with excessive alcohol consumption, especially when we've got those high alcohols or um, high percentage alcohol, like vodka, whisky, et cetera. And then also you've got things like hot beverages as well and HPV. Interesting enough. So you see that a lot and also another risk factor for, um, cervical cancer. Um, and squamous cell carcinoma is probably the most common cancer. You're gonna be seeing when we talk about esophageal cancers. Um and then a adenocarcinomas, we're talking about the, then the lower part um of the abdomen, uh of the esophagus going into the abdomen and the th lower thoracic. So here we're gonna be seeing go as a risk factor. Our esophagus again, obesity, smoking can be.