12 Cancer of the Gut

Question 1

What questions do you ask the patient with dysphagia in a clinic

Answer 1

How long?
What can't you swallow?
Vomiting?
Other symptoms?
Associated risk factors: obesity, smoking, acid reflux, alcohol

Question 2

Name the cell type or cancer of:

1) squamous epithelial cell
2) adenocarcinoma
3) enterochromaffin cell
4) GI stromal tumour
5) smooth muscle cell
6) adipocyte tissue

Answer 2

1) squamous cell carcinoma
2) glandular epithelium
3) carcinoid tumour
4) interstitial cells of Cajal
5) leiomyoma/leiomyosarcoma
6) lipoma

Question 3

Compare squamous carcinoma and adenocarcinoma of oesophageal cancer in terms of its cell type, location, risk association and incidence in the world

Answer 3

Cell type: squamous epithelial and metastatic columnar cell
Location: upper 2/3 and lower 1/3
Risk association: acetaldehyde and acid reflux
Less developed world and more developed world
*both are associated with heavy drinkers and smokers and drinking hot tea

Question 4

What is the progression from reflux to cancer

Answer 4

Oesophagitis -> barrette’s oesophagus (metaplasia) -> dysplaysia -> carcinoma (neoplasia)

Question 5

What is the investigation method for a suspected oesophageal cancer

Answer 5

Colonoscopy

Question 6

What are the risk factors for bowel cancer

Answer 6

Genetics: HNCPP, FAP, Lynch syndrome
Family history
Uncontrolled ulcerative colitis
Age
Previous polyps

Question 7

What is the progression of colon carcinoma from normal epithelium

Answer 7

Hyperproliferative (COX-2 hyper expression)
Small adenoma
Large adenoma
Colon carcinoma

Question 8

Colorectal cancer symptoms

Answer 8

Asymptomatic (incidental anaemia due to unnoticed bleeding such as in the caecum)
Change of bowel habits (diarrhoea or constipation)
Blood in stool
Acute intestinal obstruction

Question 9

List the advantages and disadvantages of colonoscopy

Answer 9

Advantages:
- high sensitivity
- relatively quick (<60 min)
- safe
- able to obtain tissue
Disadvantages:
- 2 days of iatrogenic diarrhoea
- small risk of perforation
- risk of dehydration

Question 10

What is the Virchow’s triad in pancreatic cancer

Answer 10

Pain - 70%
Anorexia - 10%
Weight loss - 10%

Question 11

What are the risk factors of pancreatic cancer

Answer 11

Family
Obesity
Alcohol
Smoking