15 - GI Malignancy Flashcards
What are the most common GI malignancies in the UK in order?
- Bowel
- Pancreas
- Oesophagus
- Stomach
- Liver
(Bowel is 3rd most common cancer all over if you remove breast and testicular)
What are some general symptoms for upper and lower GI malignancies?
What is a common presentation of oesophageal cancer and what are some red flags along with this presentation?
Dysphagia: could be due to extraluminal, luminal or intra luminal reasons
What are the red flags in this case?
- Dysphagia
- 3 months
- Tired (anaemia)
- Loss of weight
What are the two main forms of oesophageal cancer and what is the prognosis for this type of cancer??
- Sqaumous cell carncinoma
- Adenocarcinoma (Barrett’s oesophagus)
What are some differentials for epigastric pain?
What are some red flags that can occur with epigastric pain that point towards a stomach malignancy?
- Malaena
- Haematemesis
What is the most common type of stomach cancer?
- Adenocarcinoma from metaplasia or chronic gastritis
- Ulcers can be potentially malignant
- Occur mainly in the cardia or antrum
What are the risk factors for stomach adenocarcinoma and what is the prognosis with this type of cancer?
- Smoking, high salt diet, family history, H.Pylori
- Anything that causes chronic inflammation
- Most stomach cancers present late so are advanced and poor prognosis
Apart from adenocarcinomas, what other types of malignancy can occur in the stomach?
- Gastric lymphoma: MALT tissue, associated with H Pylori and has better prognosis. Most common primary site for gastrointestinal lymphoma
- Gastrointestinal stromal tumours: sarcomas and tend to find them accidentally on endoscopy
What are some red flags with jaundice for liver malignancy?
- Hepatomegaly with irregular craggy border
- Unintentional weight loss
- Painless
- Ascites due to liver damage or compression so less proteins made
What is the most common malignancy of the liver?
- Primary malignancy is rare but if it is, hepatocellular carcinoma from diseases like Hep B
- Gets a lot of metastases from BLTKP
What are the risk factors for pancreatic cancer and what is the typical patient with this type of cancer?
- Over 60 usually with no specific cause
- Chronic pancreatitis, smoking and family history all increase risk
- Prognosis very poor, about 6 months
What is the most common type of pancreatic cancer?
- Ductal adenocarcinoma
- Head of the pancreas
What are some of the symptoms of pancreatic cancer?
- Painless jaundice as interferes with biliary flow
- Persistent pain that gets worse
- Weight loss
- Anorexia
- Fatigue
- Abnormal LFTs
What is the most common type of small bowel cancer, what are the symptoms and risk factors?
- Adenocarcinoma
- VERY RARE even though it has a rapid cell turn over
What symptoms can bowel obstruction cause and how can we diagnoses a bowel obstruction?
- Abdominal pain
- Abdominal distension
- Nausea/vomiting
- Complete constipation (no flatulence or stool)
- Do an abdominal x-ray and measure the diameters of each bowel
What are some differentials for bowel obstruction?
What are some red flags with bowel obsruction for malignancy?
- Unexplained abdominal pain in the umbilical regin before obstruction
- Unintentional weight loss
What are some differential diagnoses for PR bleeding?
What are some red flags with PR bleeding that could suggest a bowel malignancy?
Red flags are age dependent
What can be some changes in bowel habit and what are some benign differentials for this?
- Change in frequency
- Change in consistency
- Associated symptoms like bloating or abdominal discomfort
What are some red flags with changes in bowel habit?
What is the most common type of large bowel cancer and what are the risk factors for this?
- Adenocarcinoma
- Usually adenomas from FAP undergo malignant changes. (Adenoma-Carcinoma sequence)
- Risks: family history, IBS, FAP, HNPCC, diet and lifestyle
How do we screen for bowel cancer in the UK?
- Faecal occult to check for hidden blood then colonoscopy if so
How can we view colorectal cancers and what is the most common site for them?
All colorectal cancers are adenocarcinomas
- 50% rectal
- 30% sigmoid
Can view most of them using sigmoidoscope
What are symptoms of rectal cancer and why?
- PR bleeding as ulcerating
- Tenesmus due to distension of rectum
What are the differences between right and left sided colon cancers?
- Left: stenosing. obstructive symptoms due to stenosis and harder contents
- Right: presents later and more advanced as caecum and ascending colon are more distensible
What is this sign and what is the diagnosis?
- Apple core sign
- Stenosis showing large bowel obstruction and often malignant
How do we stage colorectal cancers?
A - confined to mucosa
B - musculature
C - musculature and regional lymph node involvement
D - metastases
How do we manage a GI malignancy once we have a patient with red flags for it?
Investigations: TNM, blood tests for tumour markers and Hb, CT/MRI, endoscopy
Treatment: chemo, radio, surgical resections
What are tumour markers for pancreatic and bowel cancer?
Bowel: CEA
Pancreatic: CA19-9
Which part of the stomach is most prone to ulceration?
- Lesser curve
- First part of duodenum
What hormone is released in excess in Zollinger-Ellison syndrome?
What blood test result when raised would most specifically indicate hepatocyte damage?
- ALT
- ALP is biliary and bone disease
- AST not specific to liver as released from skeletal and cardiac muscle too
