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BRS GASTROENTEROLOGY > 1b GI Cancer > Flashcards

1b GI Cancer Flashcards

1
Q

What is a cancer?

A

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

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2
Q

What is the difference between primary and secondary cancer?

A

Primary = arising directly from cells in an organ
Secondary = Spread from another organ, directly or by other means (blood and lymph)

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3
Q

What are cancers from squamous epithelium called?

A

Squamous Cell Carcinoma (SCC)

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4
Q

What are cancers of glandular epithelium called?

A

Adenocarcinoma

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5
Q

What are cancers of enteroendocrine cells called?

A

Neuroendocrine tumours (NETs)

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6
Q

What are cancers of the interstitial cells of Cajal (in ciruclar muscle) called?

A

Gastrointestinal Stromal Tumours (GISTs)

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7
Q

What are cancers of the smooth muscle called?

A

Leiomyoma / leiomyosarcomas

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8
Q

What are cancers of the adipose tissue called?

A

Liposarcomas

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9
Q

What are the three forms of colorectal cancer?

A

Sporadic
Familial
Hereditary syndrome

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10
Q

Describe the histopathology of colorectal cancer?

A

Adenocarcinoma

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11
Q

Which type of colorectal cancer is present in older populations, with an absence of family history and generally an isolated lesion?

A

Sporadic

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12
Q

Which type of colorectal cancer is present with patients with a family history, younger age of onset and specific gene defects?

A

hereditary syndrome

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13
Q

What can cause the normal epithelium to become hyperproliferative epithelium?

A

Aspirin and other NSAIDs
Folate
Calcium

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14
Q

Which mutation is involved with the formation of hyperproliferative epithelium?

A

APC mutation

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15
Q

Which mutation is involved with the formation of a large adenoma?

A

K-Ras mutation

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16
Q

What causes the formation of a large adenoma from a small adenoma?

A

Oestrogen
Aspirin and other NSAIDs

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17
Q

Which two genetic events result in the formation of a colon carcinoma from a large adenoma?

A

Loss of 18q
p53 mutation

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18
Q

What are the past history risk factors for colorectal cancer?

A

Colorectal cancer, Adenoma, ulcerative colitis, radiotherapy

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19
Q

Having which condition in your family history will increase the risk of colorectal cancer?

A

Peutz-Jegher’s syndrome - rare disorder in which growths called polyps form in the intestines

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20
Q

What are the diet and environmental risk factors for colorectal cancer?

A

Carcinogenic foods
Smoking
Obesity
Socioeconomic status

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21
Q

What are the clinical presentations of caecal and right sided cancer?

A

Iron deficiency anaemia (most common)
Change of bowel habit (diarrhoea)
Distal ileum obstruction (late)
Palpable mass (late)

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22
Q

What are some clinical presentations of left sided and sigmoid carcinoma?

A

PR bleeding, mucus
Thin stool - late sign

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23
Q

What are some symptoms of a rectal carcinoma?

A

PR bleeding, mucus
Tenesmus - continutally needing to empty bowels
Anal, perineal, sacral pain (late)

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24
Q

What are some signs of a local invasion?

A

Bladder symptoms
Female genital tract symptoms

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25
What are some signs of a metastasized colorectal cancer ?
Liver (hepatic pain, jaundice) Lung (cough) Regional lymph nodes Peritoneum - Sister Marie Joseph nodule
26
What sign indicates metastasis of colorectal cancer?
Sister Marie Joseph Nodule
27
What are examination signs of primary cancer?
Abdominal mass DRE: most <12cm dentate and reached by examining finger Rigid sigmoidoscopy Abdominal tenderness and distension – large bowel obstruction
28
What are some signs of metastasis of colorectal cancer which involve other body systems?
Hepatomegaly (mets) Monophonic wheeze – lung metastasis Bone pain
29
What is the FIT test?
FIT (Faecal Immunochemical Test) - detects minute amounts of blood in faeces (faecal occult blood). 
30
Which tumour marker is a good indicator of colorectal cancer?
Tumour markers: CEA which is useful for monitoring
31
What is the difference between colonoscopy and FlexiSigmoid?
colonoscopy goes the whole way around, flexi is only in the sigmoid colon
32
what are the benefits of a colonoscopy?
- visualise lesions - remove small polyps - reduce incidence of cancer
33
Which imaging / investigations is used to visualise lesions that are > 5mm in size?
CT colonoscopy/colonography
34
What is the benefit of an MRI of the pelvis?
You are able to visualise the depth of invasion, no bowel prep or sedation is involved
35
What is used to stage colorectal cancer?
CT chest / Abdo / Pelvis
36
What is the primary management of colorectal cancer?
Surgery Sometimes stent / radiotherapy / chemotherapy
37
How is an obstructing colon carcinoma of the right and transverse colon managed?
Resection and primary anastomosis
38
What is the management of a left sided bowel obstruction?
Hartmann’s procedure Primary anastomosis Palliative Stent
39
What is a palliative stent in the management of colorectal cancer?
A stent placed in the colon in order to widen the colon so that faeces can pass through
40
What type of resection is done when the tumour is in the cecum?
Right hemicolectomy
41
What procedure is done when the tumour is in the ascending colon - right side?
Right and transverse portion of the colon removed in an extended right hemicolectomy
42
What procedure is done when the cancer is left sided, in the descending colon?
left side resected
43
What procedure is done when the cancer is in the rectum?
Formation of a J pouch - join the colon to the anus
44
What is a HCC?
hepatocellular carcinoma The primary liver cancer
45
What causes HCC?
(cirrhosis, hepatitis, alcoholic liver disease)
46
What is the optimal treatment for HCC?
surgical excision
47
What causes gall bladder cancer?
- GS - porcelain GB - chronic typhoid infection
48
What is a ChCA?
Cholangiocarcinoma
49
What causes a ChCA?
- PSC (Primary sclerosing cholangitis) & Ulcerative Colitis - liver fluke (clonorchis sinesis) - choledochal cyst
50
What is RFA?
Radiofrequency ablation a minimally invasive technique that shrinks the size of tumors, nodules or other growths in the body. RFA is used to treat a range of conditions, including benign and malignant tumors, chronic venous insufficiency in the legs, as well as chronic back and neck pain.
51
What treatment combination is the most effective to treat secondary liver metastasis of colorectal cancer?
IFL + BV
52
What is the most common form of pancreatic cancer?
pancreatic ductal adenocarcinoma
53
what is the most important risk factor for pancreatic cancer?
chronic pancreatitis
54
What lifestyle factor increases the risk of Pancreatic Ductal Adenoma?
Cigarette smoke
55
Describe the pathogenesis of pancreatic cancer?
PDAs evolve through non-invasive neoplastic precursor lesions, which acquire clonally selected genetic and epigenetic alterations along the way. The pathogenesis involves Pancreatic Intraepithelial Neoplasias (PanIN)
56
What PanIN?
Pancreatic intraepithelial neoplasia (PanIN) is considered a precursor for invasive pancreatic cancer. PanIN is defined as a microscopic papillary or flat and noninvasive epithelial neoplasm arising from the pancreatic ductal epithelium.
57
What are the clinical presentations of pancreatic cancer of the head of the pancreas?
Jaundice Weight Loss Pain Gastrointestinal Bleeding
58
What is the name of the sign where you have a palpable gall bladder?
Courvoisier Sign
59
What are the causes of weight loss seen in pancreatic cancer?
anorexia malabsorption diabetes
60
Why does gastrointestinal bleeding occur in pancreatic cancer?
duodenal invasion or varices secondary to portal or splenic vein occlusion.
61
Cancer of which part of the pancreas is asymptomatic in early stages?
carcinoma or the body and tail of the pancreas
62
What do 60% of patients with pancreatic cancer of the body and tail present with?
Marked weight loss with back pain - no jaundice
63
Which tumour marker is used to indicate pancreatic cancer?
Tumour marker CA19-9
64
Which condition is CA19-9 falsely elevated in?
pancreatitis, hepatic dysfunction and obstructive jaundice
65
What condition is used to accurately predict the resectability of a pancreatic tumour?
Dual-phase CT
66
What is ultra sonography?
- can identify pancreatic tumours - dilated bile ducts - liver metastases
67
What imaging techniques are used for pancreatic cancer?
MRI imaging detects and predicts resectability with accuracies similar to CT MRCP provides ductal images without complications of ERCP * ERCP - confirms the typical ‘double duct’ sign - aspiration/brushing of the bile-duct system - therapeutic modality → biliary stenting to relieve jaundice
68
Which imaging technique is used to see the double duct sign?
ERCP
69
What is the double duct sign?
A double-duct sign is the combined dilatation of the common bile duct and pancreatic duct, often caused by cancer of the pancreas.
70
Which imaging technique should be used for small tumour detection?
EUS
71
What does laparoscopy and laparoscopic ultra sound detect?
- detect radiologically occult metastatic lesions of liver & peritoneal cavity
72
What are NETs?
neuroendocrine tumours which arise from the gastroenteropancreatic tract
73
Which condition are NETs associated with?
Multiple Endocrine Neoplasia Type 1 (MEN1)  Parathyroid tumours Pancreatic tumours Pituitary tumours 
74
What are secreted in NETs?
Secretion of hormones & their metabolites in 40% serotonin, tachykinins (substance P) & other vasoactive peptides
75
What dermatological condition arises from NETs?
carcinoid syndorme
76
What are the symptoms of carcinoid syndrome?
VIBE: Vasodilatation Bronchoconstriction ↑ed intestinal motility Endocardial fibrosis (PR & TR)
77
What are the clinical features of insulinoma?
Hypoglycaemia, Whipple’s triad Whipples - symptoms of low glucose, low glucose and resolved when glucose in ingested
78
What are the clinical features of glucagonoma?
Diabetes mellitus, necrolytic migratory erythema ALpha cells
79
What are the clinical features of a gastrinoma?
Zollingere-Ellison syndrome
80
What are the clinical features of a VIPoma?
Verner-Morrison syndrome, watery diarrhoea
81
What are the clinical features of a somatostatinoma?
Gallstones, diabetes mellitus, steatorrhoea Steatorrhoea = faeces with fat in it
82
What is a secretory product of NETs?
Chromogranin A
83
What imaging is done to diagnose NETs?
Cross-sectional imaging (CT and/or MRI) Bowel imaging (endoscopy, barium follow through, capsule endoscopy) Endoscopic ultrasound Somatostatin receptor scintigraphy 68Ga-DOTATATE PET/CT most sensitive
84
What is the mitoses requirement for G1-G3 cancer?
G1 - <2/10 H.P.F G2 - 2-20/10 H.P.F G3 - >20/10 H.P.F
85
What is Ki-67? what are levels in each grade?
Marker of proliferation less than or equal to 2% = G1 3-20% = G2 > 20% = G3
86
How differentiated is a high grade neuroendocrine carcinoma?
Poorly differentiated
87
what is the most common sites of primary GEP-NET?
Small intestine
88
What is the most common / effective treatment for NETs?
Curative resection
89
What are the four types of liver cancers?
Hepatocellular cancer Gallbladder cancer Cholangiocarcinoma Colorectal cancer liver metastases
90
Which GI cancers can cause iron deficiency anaemia?
2. Colonic adenocarcinoma 3. Gastric carcinoma
91
What are the generic symptoms of malignancy?
Weight loss, anorexia, malaise
92
What are some symptoms which might suggest colorectal cancer?
Change in bowel habit Blood or mucus in stool Faecal incontinence Feeling of incomplete emptying of bowels (tenesmus)
93
What should you do to determine whether there is blood in the stool which the patient hasn't noticed?
Perform a digital rectal examination. Dip the urine to check for blood.

BRS GASTROENTEROLOGY (25 decks)

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