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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
How is gastric cancer treated?
``` Screening ( no programme in UK) Curative surgery (remove part of stomach and reconstruct) ```
26
What are the rare cancers in the stomach?
``` Gastric lymphoma (MALT) GIST, Gastro intestinal stromal tumour (sarcoma) ```
27
What are the 3 differentials of jaundice?
``` Pre-hepatic = too much haem Hepatic = reduced hepatocytes function Post-hepatic = obstructive causes ```
28
What are red flag symptoms in a patient with jaundice?
Unintentional weight loss Hepatomegaly with irregular border ‘craggy’ Ascites Painless
29
Why do malignancies of the liver cause oedema?
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.
30
What malignancies can occur in the liver?
Hepatocellular carcinoma - rare | Metastasis (due to portal circulation)
31
What is the biggest risk factor of hepatocellular carcinoma?
Cirrhosis/ underlying chronic inflammatory condition of the liver
32
Why are metastatic cancers common in the liver?
As the liver receives a dual blood supply via the systemic circulation and the portal circulation.
33
What metastatic cancers commonly spread to the liver?
``` Breast Colon Lung Skin Ovaries Pancreas ```
34
What different types of metastatic tumours can happen in the liver?
Haematogenous - spread in the blood Lymph - spread in the lymph (carcinomas) Transcoelomic - spread via the peritoneal cavity (ovarian)
35
What non-hepatic cancer can cause jaundice?
Pancreatic cancer
36
What are the different types of pancreatic cancer?
Ductal adenocarcinoma Neuroendocrine Cholangiocarcinoma
37
What is a ductal adenocarcinoma?
The most prevalent type of pancreatic neoplasm Develops in the exocrine compartment Poor prognosis and treatment
38
What cancer can produce excess insulin?
Neuroendocrine
39
How can the location of a ductal adenocarcinoma affect the symptoms?
Head = compression of the bile ducts resulting in no bile flow = jaundice Tail / body = malabsorption = steatorrhoea
40
What is steatorrhoea?
Presence of fat in stool Foul smelling, oily, pale, hard to flush As cant release proper enzymes to digest food.
41
What are risk factors for pancreatic cancer?
Family history Smoking Male Increased age (60+)
42
What is cholangiocarcinoma?
Malignancy of the bile ducts
43
What are risk factors of cholangiocarcinoma?
Elderly | Primary sclerosis cholangitis
44
What is primary sclerosing cholangitis
Long term progressive disease of the liver and gallbladder characterised by inflammation and scarring of the bile ducts
45
What is epigastric pain?
Pain in the upper medial abdomen
46
What can cause epigastric pain?
Oesophagitis Peptic ulcer Perforated ulcer Pancreatitis
47
What are the 3 key symptoms of a lower GI malignancy?
1. Obstruction 2. Per Rectum (PR) bleeding 3. Change in bowel habit
48
What are the general symptoms for lower GI obstruction?
Abdominal distension, abdominal pain
49
What are benign cause of lower GI obstruction?
``` ◦ Volvulus ◦ Diverticular Disease ◦ Hernias ◦ Strictures ◦ Intussusception ◦ Pyloric stenosis ```
50
How do obstructions in the large and small bowel present differently?
Small bowel - nausea/ vomiting | Large bowel - Constipation (absolute)
51
What are red flags for obstruction of the bowel?
Unintentional weight loss | Unexplained abdominal loss
52
What are benign causes of PR bleeding?
``` o Haemorrhoids o Anal fissures o Infective gastroenteritis o Inflammatory bowel disease o Diverticular disease ```
53
What needs to be considered in PR bleeding?
Nature of blood - fresh? Bright? Dark? Smelly? Malaena? Associated symptoms?
54
What are red flag symptoms for PR bleeds?
``` Age dependent Iron deficient anaemia Unexplained weight loss Change in bowel habit Tenesmus ```
55
What must be considered about change in bowel habit?
what is normal for the patient - ask Change in frequency - Diarrhoea/Constipation Change in consistency - More watery/firmer Associated symptoms - Bloating/ Abdominal discomfort
56
What are benign causes of change in bowel habit?
``` o Thyroid disorder o Inflammatory bowel disease o Medication related o Irritable bowel syndrome o Coeliac disease ```
57
What are red flags for change in bowel habit?
Age dependent Iron deficient anaemia Unexplained weight loss PR blood loss
58
What is absolute constipation and why is it more concerning?
Inability to pass any stool or wind | As greater chance of perforation of bowel
59
What is tenesmus?
Feeling of needing to defecate after opening bowels.
60
Why is tenesmus a red flag in PR bleeding?
Indicates rectal cancer as tumour is being detected by stretch receptors when the rectum is empty
61
What is the most common large bowel cancer?
Adenocarcinoma
62
What are risk factors of large bowel cancer?
o Family history o Inflammatory bowel disease o Polyposis syndromes e.g. FAP, HNPCC o Diet and lifestyle
63
What are the preventative tools for large bowel cancer?
Screening | - faecal occult test - test stool for presence of blood. If positive send for colonoscopy
64
How do left sided and right sided large bowel cancers vary in presentation?
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
What are the 5 different types of small bowel cancer?
``` o Stromal o Lymphoma o Adenocarcinoma o Sarcoma o Carcinoid tumours ```
66
What are risk factors of small bowel cancer?
IBD Coeliac disease FAP (familial adenomatous polyposis) Diet
67
What are symptoms of small bowel cancer?
weight loss, abdominal pain, blood in stools
68
What is the general management for bowel cancers?
``` 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
Who is offered screening for large bowel cancer?
One off at 55years if at risk | 60 to 75 years : every 2 years
70
Why is familial adenomatous polyposis a risk factor for large bowel cancer?
Mutation in APC gene | - tumour suppressor gene mutation, tumours not suppressed.
71
Why is obstruction in a right sided large bowel cancer less likely?
Larger lumen | Content more liquid
72
Why does right sided large bowel cancer have a poorer diagnosis than left?
As generally more advanced on presentation due less obstruction
73
How does a left sided large bowel adenocarcinoma present on a barium enema?
Apple core presentation | Stenosing
74
What are the 2 staging systems used for lower GI cancers?
TNM mostly | Dukes’ staging
75
When is dukes staging used?
In colon cancer
76
What is assessed in TNM staging?
``` T = tumour N = nodes M = metastasis ```
77
What are the different classifications of dukes staging?
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
What tumour markers are searched for on a blood test?
CEA - carcinoembryonic antigen, marker of colorectal cancer | Ca19-9 - pancreatic tumour Marker

GI Unit (14 decks)

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