1.04 - GI Cancers Flashcards
Common types of oesophageal carcinoma.
- squamous cell carcinoma
- adenocarcinoma
Features of oesophageal squamous cell carcinoma (ESCC).
- extensive local growth
- lymph node metastasis
- middle third of oesophagus
Features of oesophageal adenocarcinoma (EAC).
- less locally invasive
- wide metastasis
- lower third of oesophagus
Risk factors for oesophageal cancer.
- male
- increasing age
- radiation therapy exposure
- elevated BMI
- GORD
- tobacco smoking
- alcohol consumption
How can oesophageal cancer be avoided?
Primarily the avoidance of environmental triggers:
- smoking cessation
- avoid excessive alcohol
- healthy diet
- regular exercise
What is Barrett’s oesophagus?
GORD - gastric acid contents irritate the oesophageal squamous mucosa causing inflammation.
Chronic exposure results in metaplastic change to glandular epithelium.
This has a risk of progressing to adenocarcinoma of the oesophagus.
Symptoms of oesophageal carcinoma.
- progressive dysphagia
- unexplained weight loss
- early satiety
- haematemesis
- melena
- chest pain
Signs of oesophageal carcinoma.
- cervical lymphadenopathy
- pleural effusion
- abdominal distension
- hepatomegaly
- jaundice
- supraclavicular lymph nodes
- axillary lymph nodes
Oesophageal cancer tumour markers.
CEA and CA19-9
Management of oesophageal carcinoma.
- endoscopic therapy
- oesophagectomy
- chemoradiotherapy
Vascular supply to the stomach.
Branches of coeliac artery:
- left gastric artery
- common hepatic artery (branches into right gastric artery)
- splenic artery (branches into short gastric arteries)
Innervation of the stomach:
a) sympathetic
b) parasympathetic
a) T6-T9 spinal cord segments
b) Vagus nerve
Most common subtype of gastric cancer.
Adenocarcinoma
Gastric cancer risk factors.
- H. pylori infection
- EBV infection
- smoking
- alcohol consumption
- obesity
- salt consumption
- radiation exposure
- male sex
- increased age
- family history
Genetic conditions that predispose to gastric cancer.
- Lynch syndrome
- familial adenomatous polyposis
- Li-Fraumeni syndrome
- Peutz-Jeghers syndrome
Symptoms of gastric cancer.
- epigastric pain
- unexplained weight loss
- dysphagia
- early satiety
- persistent vomiting
- haematemesis
- iron deficiency anaemia
Signs of gastric cancer.
- lymphadenopathy
- abdominal distension / masses
- hepatomegaly
- jaundice
- pleural effusion
Sites of lymphadenopathy in gastric cancer.
- Virchow’s node (left supraclavicular LN)
- Irish node (left axillary LN)
What is Sister Mary Joseph’s node?
Periumbilical mass suggestive of gastric cancer.
Treatment of gastric cancer.
- endoscopic resection
- gastrectomy
- chemoradiotherapy
Risk factors for pancreatic cancer.
- chronic pancreatitis
- smoking
- diabetes
- obesity
- cystic fibrosis
Prevention of pancreatic cancer.
- smoking cessation
- reduced alcohol consumption
- increased physical activity
- optimise glycaemic control
Symptoms of pancreatic cancer.
- epigastric pain
- back pain
- dark urine
- jaundice (painless)
Signs of pancreatic cancer.
- jaundice
- RUQ mass
- Courvoisier’s sign*
- epigastric mass
- hepatomegaly
- cachexia
*nontender but palpable distended gallbladder.
Tumour marker for pancreatic cancer.
CA19-9
Laboratory investigations for pancreatic cancer.
- FBC, U&Es
- LFTs & billirubin
- Serum lipase
- CA19-9
Imaging for pancreatic cancer.
First line: ultrasound scan
CT used to confirm positive findings.
EUS with biopsy.
Differential diagnoses of pancreatic mass.
- cysts
- pancreatic cancer
- lymphoma
- metastatic cancer
- chronic pancreatitis
- autoimmune pancreatitis
Prognosis of pancreatic cancer.
Poor prognosis - even in cases where tumours are completed resected, there is a high risk of recurrence and the majority of patients die from the disease.
Treatment of pancreatic cancer.
- surgical resection
- radiation
- chemotherapy
Can use pre- and post-operative CA19-9 level to measure treatment response.
Layers of the bowel wall.
Risk factors for colorectal cancer.
- increasing age (>50yrs)
- FAP
- HNPCC
- Peutz-Jeghers Syndrome
- IBD
- red meat in diet
- obesity
- alcohol
- cigarette smoking
Protective factors for colorectal cancer.
- NSAIDs
- statins
- oral contraceptive pills
What is FAP?
Familial adenomatous polyposis - mutation in APC tumour suppressor gene* allows patient to develop thousands of adenomatous polyps in their colon.
Although the polyps are benign, the majority of individuals with FAP will develop colorectal cancer by age 30 if prophylactic colectomy is not performed.
*double hit hypothesis - a minority of patients will not develop the second sporadic mutation so will be unaffected.
Inheritance pattern of FAP.
Autosomal dominant
What is HNPCC?
Hereditary nonpolyposis colorectal cancer / Lynch syndrome.
Mutation in DNA mismatch repair gene* allows dysplastic and eventual metaplastic change to the bowel, resulting in colorectal cancer.
*double hit hypothesis - a minority of patients will not develop the second sporadic mutation so will be unaffected.
What are colorectal premalignant lesions?
Adenomatous polyps are benign neoplasms that have the potential for malignant transformation.
This is known as the ‘adenoma-carcinoma sequence’.
All adenomas should be removed due to their risk of malignant transformation.
High risk features of adenomas.
- multiple adenomas
- high grade dysplasia
Most common form of colorectal cancer.
Adenocarcinoma
Symptoms of colorectal cancer.
- bowel habit change
- tenesmus
- blood in stool
- fatigue
- abdominal pain
- N+V
- weight loss
- loss of appetite
Signs of colorectal cancer.
- palpable mass in abdomen
- anaemia
- lymphadenopathy
- bowel obstruction*
- bowel perforation*
*poor prognosis
Common sites of metastatic spread of colorectal cancer.
- regional lymph nodes
- liver
- lungs
- peritoneum
Tumour marker for colorectal cancer.
CEA
Diagnostic investigation for colorectal cancer.
Colonoscopy with biopsy / polypectomy.
Genetic testing performed on colorectal tumour DNA.
Testing for KRAS mutation.
Presence suggests tumour is unlikely to respond to targeted therapy drugs.
Treatment of colorectal cancer.
- local excision
- bowel resection
- pelvic exenteration
- colostomy
- chemotherapy
- radiation therapy
- targeted therapy
Complications of bowel resection.
- pain
- bleeding
- DVT / PE
- paralytic ileus
- anastamotic leak
- infection
- erectile dysfunction
- urinary incontinence
- urgency
- frequency
Bowel cancer screening in England.
FIT tests* are used for bowel cancer screening programme for people aged 60 to 74 years, every 2 years. Currently being expanded to those aged 50 and over.
If the results come back positive, they are sent for colonoscopy.
*Faecal immunochemical tests look for human haemoglobin in the stool.
