15 GI Malignancy Flashcards
How prevalant are GI malignancies?
Bowel cancer= 4th most common cancer
What 2 types of carcinoma can occur in the oesophagus ?
- Squamous cell carcinoma
- Adenocarcinoma
Why are metastases common at presentation in patients with oesophageal carcinoma? What is the prognosis like?
Once dysphagia presents- usually later stages
Prognosis= poor - 5% survival in 5 years
What investigations can be carried out into oesophageal malignancies?
Barium swallow
OGD- endoscopy
A patient presents to you with dysphagia. What are the red flags you should check for if you are concerned about a possible malignancies?
A patient presents to you with epigastric pain. What are the red flags you should check for if you are concerned about a possible malignancies?
Malaena
Haematemesis
A patient presents with epigastric pain, haematemesis and malaena. Apart from malignancies what else may have caused by this?
Where are gastric cancers likely to be located in the stomach?
Cardia/antrum (adenocarcinomas)
How may gastric cancers present?
Malaena
Haematemesis
Epigastric pain
Weight loss
Early satiety
50% will have palpable mass
What are the risk factors for gastric cancer?
- Smoking
- High salt diet
- Family history
- H.pylori
ie Chronic inflammation
What is the prognosis for gastric cancer?
Generally poor:
10% chance- 5 year survival
50% after curative surgery
SCREENING= V.important
Apart from adenocarcinomas, what other forms of cancers found in the stomach are there?
- Gastric lymphoma
- MALT- mucosal associated lymphoid tissue
- (associated with H-pylori)- prognosis= better than gastric cancer
- Gastrointestinal stromal tumours (GISTs)
- Sarcomas (not epithelial)
- tends to be incidental finding on endoscopy
A patient presents to you with jaundice. What are the red flags you should check for if you are concerned about a possible malignancies?
Weight loss
Hepatomegaly w./ irregular border
Painless (so not gallstone)
Ascites (fluid build up in abdomen)
A primary malignancy of the liver is rare. Why is this important to know?
Common site for metastases- likely to be somewhere else ie (GI- portal vein drains directly into liver)
What cancer can spread to the liver transcoelomic (through the peritoneal cavity)?
Ovarian
How does pancreatic cancer present? (depends on where in pancreatic)
Head: Jaundice
Body/tail: symptoms more vague- relate to structure of pancreas (eg steatorrhea)
What are the risk factors for pancreatic cancer?
Family history
Being male
Smoking
Chronic pancreatitis
What is the prognosis for pancreatic cancer?
Very poor- usually talking months
What are the three key symptoms associated with a lower GI malignancy?
- Obstruction
- Per rectum bleeding
- Change in bowel habit
What are the 3 main symptoms associated with an upper GI malignancy?
- Jaundice
- Dysphagia
- Epigastric pain
A lower GI malignancy can cause an obstruction. How do we investigate an obstruction?
Patient presents with: abdominal distension, abdominal pain
Abdominal x-ray- measure diameter- widened by gas (absolute constipation)
3, 6, 9cm rule- if greater= pathological
3- small bowel
6- large bowel
9- caecum dilation
List some benign differentials for bowel obstruction.
- Volvulus
- Hernia
- Intussusception- inversion of tube
- Strictures
- Pyloric stenosis
Give some of the benign differentials for per rectum bleeding.
- Haemorrhoids
- Anal fissures
- Infective gastroenteritis
- IBD
- Diverticular disease
What determines the nature of per rectal bleeding?
A patient presents to you with per anal bleeding. What are the red flags you should check for if you are concerned about a possible malignancies?
- Iron deficiency anaemia
- Explained weight loss
- Change in bowel habit
- Tenesmus (growth in rectum- always feeling like you need the toilet and not feeling fully empty)
What changes in bowel habit can occur (ie symptoms)?
Give some other causes of changes in bowel habit (not malignancy).
Thyroid disease
Irritable bowel disease
Irritable bowel syndrome
Medication related
Coeliac disease
Inflammatory bowel disease
A patient presents to you with changes in bowel habit. What are the red flags you should check for if you are concerned about a possible malignancies?
- PR blood loss
- Unexplained weight loss
- Iron deficiency anaemia
How is screening for large bowel cancer carried out?
Faecal occult blood samples
What are the risk factors for large bowel cancer?
- Family
- Inflammatory bowel disease
- Polyposis syndromes
- Diet and lifestyle
How do polyps develop into adenocarcinoma?
Differentiate between the presentation of right sided colon cancer and left sided colon cancer.
What sign might you get on an x-ray with colon cancer?
List the 5 different types of small bowel cancer. What are the risk factors and what are the symptoms?
Outline dukes’ staging (used for bowel cancers).
Outline the general management for bowel cancers
What type of cancers are colorectal cancers?
Adenocarcinomas
50% in rectum
30% in sigmoid colon
