16 Cancer Flashcards

1
Q

Q: What is cancer? Primary cancer? Secondary? Most common cancer of GIT?

A

A: disease caused by an uncontrolled division of abnormal cells in a part of the body.

Primary cancers arise directly from the cells in an organ.

Secondary cancers and metastases spread from another organ, directly or by other means (blood or lymph).

colon

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2
Q

Q: Oesophageal cancer. Name 2. Where does an the first arise? (2) Related to? Where is it more prevalent?

Where does the second arise? (2) Pathway? Where is it more prevalent?

A

A: adenocarcinoma (glandular epithelium cancer)

  • From metaplastic columnar epithelium
  • Lower 1/3 of oesophagus
  • Related to acid reflux
  • More developed world

Squamous cell carcinoma

  • From normal oesophageal squamous epithelium
  • Upper 2/3 of oesophagus
  • Acetaldehyde pathway
  • Less developed world
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3
Q

Q: What investigations are carried for colon cancer? (5)

A
A: Abdominal radiograohy (X-ray)
Plain computer tomography (CT)
Barium Enema
Colonoscopy* best
CT virtual colonoscopy
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4
Q

Q: What are the risk factors for colon cancer? (6)

A
A: Family History
Specific inherited conditions
(Familial adenomatous polyposis, Hereditary non-polposis colon cancer) FAP, HNPCC, Lynch Syndrome
Uncontrolled Ulcerative Colitis
Age
Previous Polyps
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5
Q

Q: When is pancreatic cancer often diagnosed? Outcome? (2) What is the effect of surgery? 1 year survival? 5 year?

A

A: diagnosis is often very late

Generally, the outcome is poor and only 20% are suitable for a resection.

Surgery is curative in 20-25% of cases; 1-year survival 18%, and 5-year survival 2%.

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6
Q

Q: What are the early symptoms for pancreatic cancer? (3) Subsequent advance symptoms? (4)

A

A: -depression

  • abdominal pain
  • glucose intolerance
  • weight loss
  • jaundice
  • ascites = accumulation of protein-containing (ascitic) fluid within the abdomen
  • gall bladder obstructions.
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7
Q

Q: Name 4 risk factors for pancreatic cancer?

A

A: Smoking
Drinking
Obesity
Family - Especially rare conditions such as MEN

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8
Q

Q: What are the cells of the GIT? (name 3 types and 2 examples for each)

A

A: Epithelial Cells

  • Squamous
  • “glandular epithelium”

Neuroendocrine Cells

  • Enterochromaffin cells
  • Interstitial cells of Cajal

Connective Tissue

  • Smooth muscle
  • Adipose tissue
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9
Q

Q: What type of cancer can arise from:

(Epithelial Cells)

  • Squamous
  • “glandular epithelium”

(Neuroendocrine Cells)

  • Enterochromaffin cells
  • Interstitial cells of Cajal

(Connective Tissue)

  • Smooth muscle
  • Adipose tissue

Main?

A

A: Squamous Cell Carcinoma
Adenocarcinoma**

Carcinoid tumours
Gastrointestinal Stromal Tumours

Leiomyoma/leiomyosarcomas
Lipomas

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10
Q

Q: What are the 5 steps in the development for adenocarcinoma? Where can it happen? (2)

A

A: of glandular epithelium

  1. Normal epithelium
  2. Hyperplasia - abnormal proliferation of epithelial cells (barretts)
  3. Development of adenomatous polyps
  4. Development of adenocarcinoma
  5. Metastasis

oes and colon

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11
Q

Q: What are the main causes of squamous cell carcinoma? (3) Explain one cause. Where is it more common? why?

A

A: Main causes are tobacco smoking and chewing, alcohol consumption, and ingestion of caustic substances.

The link to alcohol is due to the acetaldehyde metabolite, which damages the epithelial cells.

This is more common in the Asian population, where mutations in the acetaldehyde dehydrogenase enzyme leads to build up of this metabolite, increasing the risk of cancer.

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12
Q

Q: What is the 6 stage development of squamous cell carcinoma?

A

A: 1. Normal epithelium

  1. Metaplasia - development of abnormal squamous cell
  2. Dysplasia - proliferation of abnormal cells
  3. Severe dysplasia - almost all cells are abnormal
  4. Development of squamous cell carcinoma (neoplasia)
  5. Metastitsis
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13
Q

Q: When do the symptoms of oesophageal cancer arise? What are they? (4) In later stages, further symptoms include? (4)

A

A: Symptoms do not usually appear until a >50% of the circumference of the oesophagus is cancerous. This is due to the tumour narrowing the tube.

Difficulty and pain when swallowing
Weight loss - due to lack of nutrition
Pain in the breast bone and stomach, or a feeling of reflux

Nausea, vomiting, and regurgitation of food
Vomiting blood, due to trauma to the tumour

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14
Q

Q: Name 3 clinical investigations for oesophageal cancer. What do they each do?

A

A: Endoscopy, called an ‘oesophagogastroduodenoscopy’. Includes using a camera to observe the tumour, and a biopsy to evaluate the cells by histology

CT scan to check for metastasis

Endoscopic ultrasound - to determine level of invasion

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15
Q

Q: How does oesophageal anatomy change?

A

A: more smooth at top and more skeletal at end

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16
Q

Q: What is neoplasia?

A

A: presence or formation of new, abnormal growth of tissue

17
Q

Q: What is barretts oesophagus?

A

A: metaplasia (replacement of one differentiated cell type with another) due to chronic inflammation

Replacement of the Squamous cell mucosa with columnar mucosa

18
Q

Q: What are the main causes of colorectal cancer? (6) Current screening programme?

A

A: old age, and lifestyle factors including diet (link to consumption of red meat and processed meat), alcohol, obesity, tobacco smoking and lack of physical activity.

screening of the population exists in the form of a faecal sample, which tests for the presence of blood. Currently offered every 2 years for those over 60 years of age.

19
Q

Q: What is oesophageal adenomacarcinoma related to? (4)

A

A: Related to acid reflux - repeated damage to the epithelium. Also associated with obesity, but due to unknown cause, tobacco smoking and alcohol consumption.

20
Q

Q: In terms of genetics, what can cause colonic adenocarcinoma? Inheritance?

A

A: Not a single gene process

Sequence of genetic errors
APC, K-ras, p53, 18q

Inheritance therefore not simple Mendelian

21
Q

Q: What are the symptoms for colon adenocarcinoma? (4)

A

A: Asymptomatic (incidental anaemia)-> esp caecum

Change in Bowel Habit
Diarrhoea (seen more)
Constipation

Blood in Stool

Acute intestinal obstruction

22
Q

Q: What symptoms are not associated with colorectal cancer? (6)

A

A: Rectal bleeding with anal symptoms
Itch / Soreness / discomfort
External lump
prolapse
Change in bowel habit to harder or less frequent stool
Abdominal pain in the absence of obstruction

23
Q

Q: What are the advantages of an abdominal X ray? (3) Down? (2)

A

A: Cheap
Easy
Quick

Sensitivity for obstruction 77%
Specificity for obstruction 50%
=> not v useful

24
Q

A: What are the advantages of a plain CT? (3) Disadvantages? (3)

A

A: Quick
Easy
See large lesions

May miss smaller lesions
No tissue
No therapy

25
Q

Q: What is a barium enema? Advantages? Downsides? (3)

A

A: barium is put in large intestine through anus -> get radiologic view with scanning

Reasonable Sensitivity and Specificity

Time Intensive
Technically demanding
Unacceptable to patients

26
Q

Q: 4 advantages of a colonoscopy? Downside? (3)

A

A: Safe
Relatively quick
High Sensitivity
Able to obtain tissue

bowl prep:
2 days of iatrogenic diarrhoea
Small risk of perforation (<1:2000)
Risk of dehydration

27
Q

Q: What is needed to a CT virtual colonoscopy? (3) Advantages? (4) Downsides? (2)

A

A: Modified (reduced) bowel prep

“tag” stool using Bismuth

Computer aided subtraction to create images

Quick
Easy
Reduced Bowel prep more tolerable
As good as colonoscopy for lesions >6mm

Unable to obtain tissue
Unable to remove lesions

28
Q

Q: What is dysplasia?

A

A: expansion in immature cell types replacing more mature cells