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GI Unit > 8.1 GI Malignancy > Flashcards

8.1 GI Malignancy Flashcards

1
Q

What is dysphagia?

A

Difficulty swallowing

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2
Q

What are benign causes of dysphagia?

A

Strictures
Foreign bodies
Nerves

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3
Q

What epithelium is affected in squamous cell carcinoma?

A

Stratified squamous

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4
Q

What epithelium is affected in adenocarcinoma s?

A

Columnar epithelium

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5
Q

What are the most common GI squamous cell carcinomas?

A

Oesophageal cancer

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6
Q

How can the oesophagus develop adenocarcinoma?

A

Due to Barrett’s oesophagus - can only occur in the lower 1/3rd due to the dysplasia and metaplasia that occurs due to acid reflux through the LOS from the stomach

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7
Q

What are risk factors of oesophageal cancers?

A

Barretts oesophagus

Smoking

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8
Q

Why is the prognosis of oesophageal cancer poor?

A

At often metastatic at presentation. Generally well established before having symptoms

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9
Q

How are oesophageal cancers imaged?

A

Endoscopy

Barium swallow

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10
Q

Why are endoscopy preferable to barium swallows when assessing oesophageal cancer?

A

Can visualise tumour and take biopsies for further assessment. Can only visualise in barium swallow.

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11
Q

What are the 3 different locations that pathology can occur to cause dysphagia?

A

Intraluminal - foreign object
Luminal - oesophageal cancer
Extraluminal - left ventricular hypertrophy in aortic valve stenosis

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12
Q

What type of dysphagia is seen in luminal pathology of the oesophagus?

A

Progressive dysphagia. Solids initially hard to swallow, with liquids being fine. May develop to both being difficult

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13
Q

What are red flag symptoms associated with oesophageal cancer?

A

ALARM

Anaemia
Loss of weight
Anorexia / appetite lost
Recent onset of progressive symptoms (dysphagia)
Masses / Malaena
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14
Q

How are oesophageal cancers treated?

A

symptomatic care - nasogastric tube through tumours to facilitate swallowing

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15
Q

What are benign causes of epigastric pain?

A

Gastritis
Peptic ulcers
Pancreatitis

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16
Q

What red flag symptoms are associated with epigastric pain?

A

Malaena
Haematemesis
(Evidence of upper GI bleeding)

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17
Q

What is haematemesis?

A

Vomiting blood

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18
Q

What are possible causes of an upper GI bleed?

A 
Gastric ulcers
Duodenal ulcers
Oesophageal Varices
Mallory-Weiss syndrome 
Gastric cancer
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19
Q

How do patients with gastric cancer present?

A 
Epigastric pain
Malaena/haematemesis
Weight loss/ anorexia
Risk factors 
May have palpable mass if low BMI
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20
Q

What type of cancer is gastric cancer?

A

Adenocarcinoma

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21
Q

Where do gastric cancers commonly occur?

A

Cardia

Antrum

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22
Q

What are risk factors for gastric cancer?

A 
Smoking
High salt diet 
FHX
Increased age
Male 
Helicopter Pylori infection
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23
Q

Why can location of gastric cancer change symptoms?

A 
Cardia = anorexia, loss of appetite, weight loss, compresses oesophagus, dysphagia 
Antrum = outflow obstruction
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24
Q

How is gastric cancer diagnosed?

A

Difficult to diagnose from symptoms as present similarly to peptic ulcer
Endoscopy - biopsy of stomach to confirm/rule out malignancy

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25
Q

How is gastric cancer treated?

A 
Screening ( no programme in UK)
Curative surgery (remove part of stomach and reconstruct)
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26
Q

What are the rare cancers in the stomach?

A 
Gastric lymphoma (MALT)
GIST, Gastro intestinal stromal tumour (sarcoma)
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27
Q

What are the 3 differentials of jaundice?

A 
Pre-hepatic = too much haem
Hepatic = reduced hepatocytes function 
Post-hepatic = obstructive causes
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28
Q

What are red flag symptoms in a patient with jaundice?

A

Unintentional weight loss
Hepatomegaly with irregular border ‘craggy’
Ascites
Painless

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29
Q

Why do malignancies of the liver cause oedema?

A
  1. Decreased function of liver so less albumin synthesis and less oncotic pressure in intravascular system
  2. Tumour exerted pressure on portal system. Backflow into portal venous circulation.
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30
Q

What malignancies can occur in the liver?

A

Hepatocellular carcinoma - rare

Metastasis (due to portal circulation)

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31
Q

What is the biggest risk factor of hepatocellular carcinoma?

A

Cirrhosis/ underlying chronic inflammatory condition of the liver

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32
Q

Why are metastatic cancers common in the liver?

A

As the liver receives a dual blood supply via the systemic circulation and the portal circulation.

33
Q

What metastatic cancers commonly spread to the liver?

A 
Breast
Colon
Lung
Skin
Ovaries
Pancreas
34
Q

What different types of metastatic tumours can happen in the liver?

A

Haematogenous - spread in the blood
Lymph - spread in the lymph (carcinomas)
Transcoelomic - spread via the peritoneal cavity (ovarian)

35
Q

What non-hepatic cancer can cause jaundice?

A

Pancreatic cancer

36
Q

What are the different types of pancreatic cancer?

A

Ductal adenocarcinoma
Neuroendocrine
Cholangiocarcinoma

37
Q

What is a ductal adenocarcinoma?

A

The most prevalent type of pancreatic neoplasm
Develops in the exocrine compartment
Poor prognosis and treatment

38
Q

What cancer can produce excess insulin?

A

Neuroendocrine

39
Q

How can the location of a ductal adenocarcinoma affect the symptoms?

A

Head = compression of the bile ducts resulting in no bile flow = jaundice
Tail / body = malabsorption = steatorrhoea

40
Q

What is steatorrhoea?

A

Presence of fat in stool
Foul smelling, oily, pale, hard to flush
As cant release proper enzymes to digest food.

41
Q

What are risk factors for pancreatic cancer?

A

Family history
Smoking
Male
Increased age (60+)

42
Q

What is cholangiocarcinoma?

A

Malignancy of the bile ducts

43
Q

What are risk factors of cholangiocarcinoma?

A

Elderly

Primary sclerosis cholangitis

44
Q

What is primary sclerosing cholangitis

A

Long term progressive disease of the liver and gallbladder characterised by inflammation and scarring of the bile ducts

45
Q

What is epigastric pain?

A

Pain in the upper medial abdomen

46
Q

What can cause epigastric pain?

A

Oesophagitis
Peptic ulcer
Perforated ulcer
Pancreatitis

47
Q

What are the 3 key symptoms of a lower GI malignancy?

A
  1. Obstruction
  2. Per Rectum (PR) bleeding
  3. Change in bowel habit
48
Q

What are the general symptoms for lower GI obstruction?

A

Abdominal distension, abdominal pain

49
Q

What are benign cause of lower GI obstruction?

A 
◦ Volvulus
◦ Diverticular Disease
◦ Hernias
◦ Strictures
◦ Intussusception
◦ Pyloric stenosis
50
Q

How do obstructions in the large and small bowel present differently?

A

Small bowel - nausea/ vomiting

Large bowel - Constipation (absolute)

51
Q

What are red flags for obstruction of the bowel?

A

Unintentional weight loss

Unexplained abdominal loss

52
Q

What are benign causes of PR bleeding?

A 
o Haemorrhoids
o Anal fissures
o Infective gastroenteritis
o Inflammatory bowel disease
o Diverticular disease
53
Q

What needs to be considered in PR bleeding?

A

Nature of blood - fresh? Bright? Dark? Smelly? Malaena? Associated symptoms?

54
Q

What are red flag symptoms for PR bleeds?

A 
Age dependent 
Iron deficient anaemia 
Unexplained weight loss 
Change in bowel habit 
Tenesmus
55
Q

What must be considered about change in bowel habit?

A

what is normal for the patient - ask
Change in frequency - Diarrhoea/Constipation
Change in consistency - More watery/firmer
Associated symptoms - Bloating/ Abdominal discomfort

56
Q

What are benign causes of change in bowel habit?

A 
o Thyroid disorder
o Inflammatory bowel disease
o Medication related
o Irritable bowel syndrome
o Coeliac disease
57
Q

What are red flags for change in bowel habit?

A

Age dependent
Iron deficient anaemia
Unexplained weight loss
PR blood loss

58
Q

What is absolute constipation and why is it more concerning?

A

Inability to pass any stool or wind

As greater chance of perforation of bowel

59
Q

What is tenesmus?

A

Feeling of needing to defecate after opening bowels.

60
Q

Why is tenesmus a red flag in PR bleeding?

A

Indicates rectal cancer as tumour is being detected by stretch receptors when the rectum is empty

61
Q

What is the most common large bowel cancer?

A

Adenocarcinoma

62
Q

What are risk factors of large bowel cancer?

A

o Family history
o Inflammatory bowel disease
o Polyposis syndromes e.g. FAP, HNPCC
o Diet and lifestyle

63
Q

What are the preventative tools for large bowel cancer?

A

Screening

- faecal occult test - test stool for presence of blood. If positive send for colonoscopy

64
Q

How do left sided and right sided large bowel cancers vary in presentation?

A

Right : anaemia (occult bleeding), less likely, mass in right iliac fossa, late change in bowel habit, more advanced disease at presentation, fungating tumours

Left = PR bleeding, bowel obstruction, tenesmus, mass in left iliac fossa, early change in bowel habit, less advanced disease at presentation, stenosing.

65
Q

What are the 5 different types of small bowel cancer?

A 
o Stromal
o Lymphoma
o Adenocarcinoma
o Sarcoma
o Carcinoid tumours
66
Q

What are risk factors of small bowel cancer?

A

IBD
Coeliac disease
FAP (familial adenomatous polyposis)
Diet

67
Q

What are symptoms of small bowel cancer?

A

weight loss, abdominal pain, blood in stools

68
Q

What is the general management for bowel cancers?

A 
TNM staging 
Blood test- FBC, tumour markers (e.g. CEA, CA 19-9) 
CT/MRI 
Endoscopy/Colonoscopy
o Capsule endoscopy 
Treatment
o Chemotherapy
o Radiotherapy
o Surgical resections
69
Q

Who is offered screening for large bowel cancer?

A

One off at 55years if at risk

60 to 75 years : every 2 years

70
Q

Why is familial adenomatous polyposis a risk factor for large bowel cancer?

A

Mutation in APC gene

- tumour suppressor gene mutation, tumours not suppressed.

71
Q

Why is obstruction in a right sided large bowel cancer less likely?

A

Larger lumen

Content more liquid

72
Q

Why does right sided large bowel cancer have a poorer diagnosis than left?

A

As generally more advanced on presentation due less obstruction

73
Q

How does a left sided large bowel adenocarcinoma present on a barium enema?

A

Apple core presentation

Stenosing

74
Q

What are the 2 staging systems used for lower GI cancers?

A

TNM mostly

Dukes’ staging

75
Q

When is dukes staging used?

A

In colon cancer

76
Q

What is assessed in TNM staging?

A 
T = tumour 
N = nodes
M = metastasis
77
Q

What are the different classifications of dukes staging?

A

Dukes A = cancer confined to inner lining of bowel
Dukes B = cancer gone through muscular layer of bowel wall
Dukes C = cancer spread to lymph node
Dukes D = cancer spread to other parts of the body

78
Q

What tumour markers are searched for on a blood test?

A

CEA - carcinoembryonic antigen, marker of colorectal cancer

Ca19-9 - pancreatic tumour Marker

GI Unit (14 decks)

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