15. Cancer

Question 1

Summarise 2 types of oesophageal cancer?

Answer 1

• Adenocarcinoma (glandular structures)
- metaplastic columnar epithelium
- lower 1/3 of oesophagus
- more developed world
• Squamous cell carcinoma
- upper 2/3 of oesophagus
- acetaldehyde pathway
- less developed world

Question 2

What causes oesophageal adenocarcinoma?

Answer 2

• Acid reflux - repeated damage
• Also associated with obesity, tobacco smoking and alcohol consumption
• Occurs 10x more in men (hormonal control in women)

Question 3

What causes oesophageal squamous cell carcinoma?

Answer 3

• Tobacco smoking and chewing, alcohol consumption, ingestion of caustic substances
• Acetaldehyde metabolite damages epithelial cells
• Common in asian population - mutation in acetaldehyde dehydrogenase - build up in metabolite

Question 4

How can you investigate colon cancer?

Answer 4

• X-ray
• CT
• Barium enema
• Colonoscopy
• CT virtual colonoscopy

Question 5

Summarise the epidemiology of colon cancer

Answer 5

• More than 30,000 new cases per year
• 1 case per GP per year
• 14% of cancer in men, 12% in women
• 1 in 25 lifetime risk
• 1 in 50 risk of dying

Question 6

What are the risk factors for colon cancer?

Answer 6

• Family history
• Specific inherited confitions e.g. Lynch syndrome
• Uncontrolled Ulcerative Colitis
• Age
• Previous Polyps
• Diet, alcohol, obesity, tobacco smoking, lifestyle

Question 7

Why is pancreatic cancer referred to as the ‘silent killer’ (refer to statistics)?

Answer 7

• Often late diagnosis
• Poor prognosis
• Only 20% suitable for resection
• Surgery is curative in 20-25% of cases
• 1 and 5 year survival - 18% and 2%

Question 8

What are early symptoms of pancreatic cancer?

Answer 8

• Depression
• Abdominal pain
• Glucose intolerance

Question 9

What are the advanced symptoms of pancreatic cancer?

Answer 9

• Weight loss
• Jaundice
• Ascites
• Gall bladder obstructions

Question 10

What are the risk factors of pancreatic cancer?

Answer 10

• Smoking
• Drinking
• Obesity
• Family history

Question 11

Outline the development of adenocarcinoma

Answer 11

1) Normal epithelium
2) Hyperplasia
3) Adenomatous polyps
4) Adenocarcinoma
5) Metastasis

Question 12

Outline the development of squamous cell carcinoma

Answer 12

1) Normal epithelium
2) Metaplasia - development of abnormal squamous cell
3) Dysplasia - proliferation of abnormal cells
4) Severe dysplasia
5) Squamous cell carcinoma
6) Metastasis

Question 13

What are the initial symptoms of oesophageal cancer?

Answer 13

Don’t usually appear until >50% of circumference is cancerous (narrowing the tube)
• Difficulty and pain when swallowing
• Weight loss - lack of nutrition
• Pain in breast bone and stomach, or reflux feeling

Question 14

What are the symptoms of oesophageal cancer in the late stages?

Answer 14

• Nausea, vomiting and regurgitation of food

* Vomiting, of blood due to trauma of the tumour

Question 15

How can oesophageal cancer be clinically investigated?

Answer 15

• Endoscopy (oesophagogastroduodeoscopy)
• CT scan (for metastasis)
• Endoscopic ultrasound