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BRS 11 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 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

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

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 carcioma?

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
Q

What are some signs of a metastasized colorectal cancer ?

A

Liver (hepatic pain, jaundice)
Lung (cough)
Regional lymph nodes
Peritoneum - Sister Marie Joseph nodule

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26
Q

What sign indicates metastasis of colorectal cancer?

A

Sister Marie Joseph Nodule

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27
Q

What are signs of primary cancer?

A

Abdominal mass

DRE: most <12cm dentate and reached by examining finger

Rigid sigmoidoscopy

Abdominal tenderness and distension – large bowel obstruction

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28
Q

What are some signs of metastasis of colorectal cancer which involve other body systems?

A

Hepatomegaly (mets)
Monophonic wheeze – lung metastasis
Bone pain

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29
Q

What is the FIT test?

A

FIT (Faecal Immunochemical Test) - detects minute amounts of blood in faeces (faecal occult blood).

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30
Q

Which tumour marker is a good indicator of colorectal cancer?

A

Tumour markers: CEA which is useful for monitoring

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31
Q

What is the difference between colonoscopy and FlexiSigmoid?

A

colonoscopy goes the whole way around, flexi is only in the sigmoid colon

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32
Q

what are the benefits of a colonoscopy?

A
  • visualise lesions
  • remove small polyps
  • reduce incidence of cancer
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33
Q

Which imaging / investigations is used to visualise lesions that are > 5mm in size?

A

CT colonoscopy/colonography

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34
Q

What is the benefit of an MRI of the pelvis?

A

You are able to visualise the depth of invasion, no bowel prep or sedation is involved

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35
Q

What is used to stage colorectal cancer?

A

CT chest / Abdo / Pelvis

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36
Q

What is the primary management of colorectal cancer?

A

Surgery

Sometimes stent / radiotherapy / chemotherapy

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37
Q

How is an obstructing colon carcinoma of the right and transverse colon managed?

A

Resection and primary anastomosis

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38
Q

What is the management of a left sided bowel obstruction?

A

Hartmann’s procedure
Primary anastomosis
Palliative Stent

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39
Q

What is a palliative stent in the management of colorectal cancer?

A

A stent placed in the oesophagus in order to widen the oesophagus so that swallowing is possible

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40
Q

What type of resection is done when the tumour is in the cecum?

A

Right hemicolectomy

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41
Q

What procedure is done when the tumour is in the ascending colon - right side?

A

Right and transverse portion of the colon removed in an extended right hemicolectomy

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42
Q

What procedure is done when the cancer is left sided, in the descending colon?

A

left side resected

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43
Q

What procedure is done when the cancer is in the rectum?

A

Formation of a J pouch - join the colon to the anus

44
Q

What is a HCC?

A

hepatocellular carcinoma

The primary liver cancer

45
Q

What causes HCC?

A

(cirrhosis, hepatits, alcoholic liver disease)

46
Q

What is the optimal treatment for HCC?

A

surgical excision

47
Q

What causes gall bladder cancer?

A
  • GS
    - porcelain GB
    - chronic typhoid infection
48
Q

What is a ChCA?

A

Cholangiocarcinoma

49
Q

What causes a ChCA?

A
  • PSC (Primary sclerosing cholangitis) & Ulcerative Colitis
    - liver fluke (clonorchis sinesis)
    - choledochal cyst
50
Q

What is RFA?

A

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
Q

What treatment combination is the most effective to treat secondary liver metastasis of colorectal cancer?

A

IFL + BV

52
Q

What is the most common cause of pancreatic cancer?

A

pancreatic ductal adenocarcinoma

53
Q

what is the most important risk factor for pancreatic cancer?

A

chronic pancreatitis

54
Q

What lifestyle factor increases the risk of Pancreatic Ductal Adenoma?

A

Cigarette smoke

55
Q

Describe the pathogenesis of pancreatic cancer?

A

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
Q

What PanIN?

A

Pancreatic intraepithelial neoplasia (PanIN) isconsidered 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
Q

What are the clinical presentations of pancreatic cancer of the head of the pancrea?

A

Jaundice
Weight Loss
Pain
Gastrointestinal Bleeding

58
Q

What is the name of the sign where you have a palpable gall bladder?

A

Courvoisier Sign

59
Q

What are the causes of weight loss seen in pancreatic cancer?

A

anorexia
malabsorption
diabetes

60
Q

Why does gastrointestinal bleeding occur in pancreatic cancer?

A

duodenal invasion or varices secondary to portal or splenic vein occlusion.

61
Q

Cancer of which part of the pancreas is asymptomatic in early stages?

A

carcinoma or the body and tail of the pancreas

62
Q

What do 60% of patients with pancreatic cancer of the body and tail present with?

A

Marked weight loss with back pain - no jaundice

63
Q

Which tumour marker is used to indicate pancreatic cancer?

A

Tumour marker CA19-9

64
Q

Which condition is CA19-9 falsely elevated in?

A

pancreatitis, hepatic dysfunction and obstructive jaundice

65
Q

What condition is used to accurately predict the resectability of a pancreatic tumour?

A

Dual-phase CT

66
Q

What is ultra sonography?

A
  • can identify pancreatic tumours
    - dilated bile ducts
    - liver metastases
67
Q

What imaging techniques are used for pancreatic cancer?

A

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
Q

Which imaging technique is used to see the double duct sign?

A

ERCP

69
Q

What is the double duct sign?

A

A double-duct sign is the combined dilatation of the common bile duct and pancreatic duct, often caused by cancer of the pancreas.

70
Q

Which imaging technique should be used for small tumour detection?

A

EUS

71
Q

What does laparoscopy and laparoscopic ultra sound detect?

A
  • detect radiologically occult metastatic lesions of liver & peritoneal cavity
72
Q

What are NETs?

A

neuroendocrine tumours which arise from the gastroenteropancreatic tract

73
Q

Which condition are NETs associated with?

A

Multiple Endocrine NeoplasiaType 1 (MEN1)
Parathyroidtumours
Pancreatic tumours
Pituitarytumours

74
Q

What are secreted in NETs?

A

Secretion of hormones & their metabolites in 40%

serotonin, tachykinins (substance P) & other vasoactive peptides

75
Q

What dermatological condition arises from NETs?

A

carcinoid syndorme

76
Q

What are the symptoms of carcinoid syndrome?

A

Vasodilatation
Bronchoconstriction
↑ed intestinal motility
Endocardial fibrosis (PR & TR)

77
Q

What are the clinical features of insulinoma?

A

Hypoglycaemia, Whipple’s triad

Whipples - symptoms of low glucose, low glucose and resolved when glucose in ingested

78
Q

What are the clinical features of glucagonoma?

A

Diabetes mellitus, necrolytic migratory erythema

ALpha cells

79
Q

What are the clinical features of a gastrinoma?

A

Zollingere-Ellison syndrome

80
Q

What are the clinical features of a VIPoma?

A

Verner-Morrison syndrome, watery diarrhoea

81
Q

What are the clinical features of a somatostatinoma?

A

Gallstones, diabetes mellitus, steatorrhoea

Steatorrhoea = faeces with fat in it

82
Q

What is a secretory product of NETs?

A

Chromogranin A

83
Q

What imaging is done to diagnose NETs?

A

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
Q

What is the mitoses requirement for G1-G3 cancer?

A

G1 - <2/10 H.P.F

G2 - 2-20/10 H.P.F

G3 - >20/10 H.P.F

85
Q

What is Ki-67? what are levels in each grade?

A

Marker of proliferation

less than or equal to 2% = G1
3-20% = G2
> 20% = G3

86
Q

How differentiated is a high grade neuroendocrine carcinoma?

A

Poorly differentiated

87
Q

what is the most common sites of primary GEP-NET?

A

Small intestine

88
Q

What is the most common / effective treatment for NETs?

A

Curative resection

89
Q

What are the four types of liver cancers?

A

Hepatocellular cancer
Gallbladder cancer
Cholangiocarcinoma
Colorectal cancer liver metastases

90
Q

What are the cardiac causes of dysphagia?

A

Post-prandial angina

91
Q

What are the Abdominal causes of upper dysphagia?

A

Structural causes: Pharyngeal cancer, pharyngeal pouch
Neurological causes: Parkinson’s, stroke, motor neuron disease

92
Q

What are the abdominal causes of lower dysphagia?

A

Structural causes:
Inside (mural and luminal): oesophageal or gastric cancer, stricture, Schatzki ring
Outside (extrinsic compression): lung cancer
Neurological causes: Achalasia, diffuse oesophageal spasm

93
Q

How to differentiate between dysphagia and angina?

A

unusual for angina to occur only after eating

Discomfort seconds after swallowing is unusual and suggestive more of dysphagia

94
Q

How to determine whether the pain is of upper or lower oesophageal origin?

A

Painful on swallowing - upper

Food easy to swallow but feels like it is getting stuck seconds later - lower

95
Q

How to determine if the cause of dysphagia is neurological or not?

A

if both solids and liquids are hard to swallow - neurological

96
Q

What would blood in the stool suggest?

A

GI malignanct

97
Q

What are the causes of microcytic anaemia?

A
  1. Iron deficiency anaemia
  2. Anaemia of chronic disease
  3. Thalassaemia
  4. Sideroblastic anaemia
98
Q

What are the causes of normocytic anaemia? ABCDE

A

ABCDE
Aplastic anaemia
Bleeding
Chronic disease
Destruction (haemolysis)
Endocrine disorders
Hypothyroidism
Hypoadrenalism

99
Q

What is the MCV for normocytic cells?

A

80-96

100
Q

What are the causes of Macrocytic anaemia?

A

FAT RBC

Foetus (pregnancy)
Alcohol excess
Thyroid disorders

Reticulocytosis
B12/Folate deficiency
Cirrhosis

101
Q

What is the MCV for macrocytic cells?

A

96

102
Q

Which GI cancers can cause iron deficiency anaemia?

A
  1. Colonic adenocarcinoma
  2. Gastric carcinoma
103
Q

What are the generic symptoms of malignancy?

A

Weight loss, anorexia, malaise

104
Q

What are some symptoms which might suggest colorectal cancer?

A

Change in bowel habit
Blood or mucus in stool
Faecal incontinence
Feeling of incomplete emptying of bowels (tenesmus)

105
Q

What should you do to determine whether there is blood in the stool which the patient hasn’t noticed?

A

Perform a digital rectal examination.
Dip the urine to check for blood.

BRS 11 Gastroenterology (25 decks)

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