1.04 - GI Cancers Flashcards by Patrick Kilgannon

Common types of oesophageal carcinoma.

squamous cell carcinoma
adenocarcinoma

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Features of oesophageal squamous cell carcinoma (ESCC).

extensive local growth
lymph node metastasis
middle third of oesophagus

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Features of oesophageal adenocarcinoma (EAC).

less locally invasive
wide metastasis
lower third of oesophagus

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Risk factors for oesophageal cancer.

male
increasing age
radiation therapy exposure
elevated BMI
GORD
tobacco smoking
alcohol consumption

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How can oesophageal cancer be avoided?

Primarily the avoidance of environmental triggers:
- smoking cessation
- avoid excessive alcohol
- healthy diet
- regular exercise

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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.

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Symptoms of oesophageal carcinoma.

progressive dysphagia
unexplained weight loss
early satiety
haematemesis
melena
chest pain

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Signs of oesophageal carcinoma.

cervical lymphadenopathy
pleural effusion
abdominal distension
hepatomegaly
jaundice
supraclavicular lymph nodes
axillary lymph nodes

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Oesophageal cancer tumour markers.

CEA and CA19-9

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Management of oesophageal carcinoma.

endoscopic therapy
oesophagectomy
chemoradiotherapy

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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)

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Innervation of the stomach:

a) sympathetic

b) parasympathetic

a) T6-T9 spinal cord segments

b) Vagus nerve

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Most common subtype of gastric cancer.

Adenocarcinoma

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Gastric cancer risk factors.

H. pylori infection
EBV infection
smoking
alcohol consumption
obesity
salt consumption
radiation exposure
male sex
increased age
family history

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Genetic conditions that predispose to gastric cancer.

Lynch syndrome
familial adenomatous polyposis
Li-Fraumeni syndrome
Peutz-Jeghers syndrome

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Symptoms of gastric cancer.

epigastric pain
unexplained weight loss
dysphagia
early satiety
persistent vomiting
haematemesis
iron deficiency anaemia

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Signs of gastric cancer.

lymphadenopathy
abdominal distension / masses
hepatomegaly
jaundice
pleural effusion

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Sites of lymphadenopathy in gastric cancer.

Virchow’s node (left supraclavicular LN)
Irish node (left axillary LN)

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What is Sister Mary Joseph’s node?

Periumbilical mass suggestive of gastric cancer.

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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.

1. FBC, U&Es 2. LFTs & billirubin 3. Serum lipase 4. 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.