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S3: Gastrointestinal > 8a.) GI Malignancy > Flashcards

8a.) GI Malignancy Flashcards

1
Q

There are numerous types of GI cancers; order the following starting with most common

A
  • Bowel
  • Pancreas
  • Oesophagus
  • Stomach
  • Liver
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2
Q

State 3 symptoms that would indicate an upper GI malignancy and 3 symptoms that would indicate a lower GI malignancy

A
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3
Q

How common is GI cancers compared to other cancers?

A
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4
Q

State the 2 main forms of oesophageal cancer

A
  • Squamous cell carcinoma
  • Adenocarcinoma (most adenocarcinomas are related to Barrett’s oesophagus)
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5
Q

Most adenocarcinomas are related to…?

A

Barrett’s oesophagus

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6
Q

What is a common presentation for oesophageal cancer?

A

Dysphagia

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7
Q

State 5 red flags associated with dysphagia

A
  • Anaemia
  • Loss of weight (unitentional)
  • Anorexia
  • Recent onset of progressive symptoms
  • Masses/Malaena
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8
Q

There are two types of oesophageal carcinoma; describe what the type of carcinoma is linked to

A

Type of carcinoma is linked to epithelial type:

  • Stratified squamous: squamous cell carcinoma
  • Columnar epithelium: adenocarcinoma
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9
Q

Describe, where in the oesophagus (e.g. proximal or distal), you are most likely to find the following:

  • Squamous cell carcinoma
  • Adenocarcinoma
A
  • Squamous cell carcinoma: most of oesophagus
  • Adenocarcinoma: lower part

NOTE: epithelium changes just above lower oesophageal sphincter

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10
Q

What is the prognosis for oesophageal carcinomas?

A

Poor- 5% survival at 5 years

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11
Q

Which type of carcinoma is more common in oesophagus and why?

A

Squamous cell carcinoma because the carcinoma type is related to the epithlial type and most of oesophagus is stratified squamous epithelium

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12
Q

Describe the typical presentation of someone with oesophageal carcinoma

A
  • Progressive dysphagia
  • Other red flags

See example:

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13
Q

Describe Barrett’s oesophagus, include:

  • What it is
  • What it is often caused by
  • It is symptomatic?
  • Is it cancerous?
  • Can it increase risk of oesophageal cancer?
A
  • Metaplasia of epithelium in distal oesophagus; changes from stratified squamous to columnar epithelium
  • GORD
  • Asymptomatic
  • Not a cancer itself
  • It can lead to dysplasia and is therefore a risk factor for cancer
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14
Q

Remind yourself of the quadrants of the abdomen and try and suggest one condition that could cause pain in that area

A
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15
Q

State some red flags associated with epigastric pain

A
  • Malaena
  • Haematemesis
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16
Q

Where in the stomach is gastric cancer typically found?

A
  • Cardia
  • Antrum
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17
Q

Describe the typical presentation of someone with gastric cancer

A
  • Epigastric pain
  • 50% palpable mass
  • Malaena
  • Haematemesis
  • Risk factors: smoking, hight salt diet, family history, Helicobacter pylori, chronic inflammation
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18
Q

State some risk factors for gastric cancer

A
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19
Q

Discuss the prognosis of gastric cancer

A

lPrognosis generally poor:

  • 10% 5 year survival
  • 50% after curative surgery
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20
Q

Where in GI tract is the most common site for a primary gastrointestinal lymphona?

A

Stomach

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21
Q

Stomach ulcers are potentially malignant; true or false?

A

True

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22
Q

What is the most important environmental factor in stomach cancer?

A

Helicobacter pylori

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23
Q

The majority of stomach cancers are what kind of carcinomas?

Majority of stomach carcinomas arsie from what 2 things?

A

Adenocarcinomas that commonly arise from:

  • Chronic gastritis
  • Metplasia
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24
Q

Other than adenocarcinomas, state two other cancers that can occur in the stomach

A
  • Gastric lymphoma
    • MALT tissue
    • Similar presentation to gastric adenocarcinoma
    • Highly associated with helicobacter pylori
    • Prognosis much better than gastric cancer
  • Gastrointestinal stromal tumours (GISTs)
    • Sarcomas (not epilthelial)
    • Tend to be an incidental finding on endoscopy
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25
Q

Suggest a reason why the prognosis for stomach cancers is often poor

A

Stomach cancers often present late and are therefore advanced once they are diagnosed/detected

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26
Q

Who does pancreatic cancer generally affect?

State 2 risk factors for pancreatic cancer

A
  • Generally affects over 60’s (with no specific cause identified)
  • Risk factors:
    • Chronic pancreatits
    • Smoking
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27
Q

State 4 red flags associated with jaundice

A
  • Hepatomegaly
    • Irregular border
  • Unintentional weight loss
  • Painless
  • Ascites
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28
Q

Primary malignancy of the liver (hepatocellular carcinoma) is very common; true or false

A

FALSE- primary malignancy of the liver is very rare

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29
Q

Suggest why the liver is a common site for metastases

A

Portal system drains entire GI tract (and also drains left testicle and ovary) hence increased probability of malignant cells going through the liver

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30
Q

Describe 3 mechanisms by which malignancies can metastasise to liver

A
  • Haematogenous: via portal system
  • Lymphatics:
    • Common in carcinomas
    • Check the sentinal lymph node
  • Spread from other systems:
    • Ovarian: transcoelomic (through peritoneal cavity)
    • Breast
    • Lung
31
Q

Describe how cancer in the head of the pancreas in comparison to the tail of the pancreas may present differently

A
  • Cancer in pancreas head: jaundice (post hepatic obstruction?)
  • Cancner in body/tail: more vague symptoms which often relate to function of the pancreas e.g. steatorrhea because lack of lipase production leading to fatty stools
32
Q

What is the most common form of pancreatic cancer and where is it found?

A

Dutal adenocarcinomas are most common and pancreatic head is most commonly affected portion of pancreas

33
Q

Explain why cancer of head of pancreas can cause jaundice?

A

Can interfere with biliary flow into duodenum leading to post-hepatic obstructive jaundice

34
Q

State somer risk factors for pancreatic cancer

A
  • Family history
  • Men
  • Age (>60yrs)
  • Chronic pancreatitis
35
Q

State some sypmtoms of pancreatic cancer

A
36
Q

State the prognosis for pancreatic cancer?

A

Poor

37
Q

What are the 3 key symptoms that could indicate lower GI malignancy?

A
  • Obstruction
  • PR bleeding
  • Change in bowel habit
38
Q

State 2 symptoms that often accompany bowel obstruction

A
  • Abdominal distension
  • Abdominal pain
39
Q

State some benign and some malignant differential diagnoses for bowel obstruction

A

Benign

  • Volvulus: torsion of a loop of intestine
  • Diverticular disease
  • Hernias
  • Strictures
  • Intussusception: part of intestine slides into adjacent part of intestine/one semgent folds into another
  • Pyloric stenosis

Malignant

  • Small bowel
  • Large bowel
40
Q

How could you differentiate between a small and a large bowel obstruction bases on symptoms?

A
  • Small bowel: nausea/vomitting
  • Large bowel: absolute constipation (can’t pass gas or faeces)
41
Q

Is the small intestine a common site for adenomas and carcinomas? Is this surprising?

A

Uncommon site for adenomas and carcinomas; this is suprising considering its large surface area and rapid cell turnover

42
Q

State some benign and some malignant differential diagnoses for PR bleeding

A

Benign

  • Haemorrhoids
  • Anal fissures
  • Infective gastroenteritis
  • IBD
  • Diverticular disease

Malignant

  • Small vs large bowel cancer
43
Q

When someone has PR bleeding we have to establish the nature of the bleeding; what do we mean by this?

A
  • Fresh blood- bright red
  • Older blood/from upper GI- malaena
  • Any associated symptoms
44
Q

State some red flags associated with PR bleeding

A
  • Age dependent
  • Fe deficient anaemia
  • Unexplained weight loss
  • Change in bowel habit
  • Tenesmus (cramping pain in rectal area that makes you feel like you need a poo when you have just had one- feeling like you need to go to toilet. Because of growth in rectum)
45
Q

State 2 red flags associated with obstruction of small or large bowel

A
  • Unintentional weight loss
  • Unexplained abdominal pain
46
Q

If someone states they have had a change in their bowel habits, what further information do we need to find out?

A
  • Change in frequency
  • Change in consistecy
  • Associated symptoms
47
Q

A patient comes to you stating they have had a change in their bowel habits. Your differential diagnoses will vary dependent on what the change in bowel habit is. State some benign differential diagnoses of change in bowel habit

A
  • Thyroid disorder
  • IBD
  • Medication related
  • IBS
  • Coeliac
48
Q

State some red flag associated with a change in bowel habits

A
  • Age dependent
  • Fe deficient anaemia
  • Unexplained weight loss
  • PR blood loss
49
Q

What is the most common colorectal cancer?

A

Adenocarcinoma

50
Q

State some risk factors for colorectal cancer

A
  • Family history
  • IBD
  • Polyposis syndromes e.g. FAP, HNPCC (
  • Diet & lifestyle
51
Q

What is familial adenomatous polyposis

A

Inherited condition where many adenomatous polyps develop and these adenomatous polps invariably undergo malignant change causing colorectal cancer

52
Q

Describe how adenomatous polyps develop into adenocarcinomas

A
  • Proliferation of polyp
  • Dysplasia occurs
53
Q

Colorectal cancers are related to a number of genetic events such as… ?(3)

HINT: think back to path pro neoplasia

A
  • Activation of oncogenes
  • Loss of tumour supressor genes
  • Ineffective DNA repair
54
Q

What % of colorectal cancers are adenocarcinomas?

A

100%

All colorectal cancers are adenocarcinomas

55
Q

What % of colorectal cancers occur in rectum and what % occur in sigmoid colon?

A
  • 50% rectum
  • 30% sigmoid colon
56
Q

Most colorectal cancers can be viewed with a…?

A

Sigmoidoscope

(as 50% occur in rectum, 30% occur in sigmoid colon)

57
Q

Describe some symptoms that would make you think the colorectal cancer is in the rectum as oppose to the colon

A

Symptoms suggest of rectal cancer:

  • PR bleeding (as rectal cancers usually ulcerating)
  • Tenesmus (due to distension of rectum)
58
Q

Compare and contrast symptoms for right sided colon cancer and left sided colon cancer

A
  • Right sided: often present later and more advanced as the caecum and colon are more distensible
  • Left sided: often get obstructive symptoms as the left sided colon cancers are usually stenosing AND contents are more solid in left side
59
Q

Small bowel cancer is common; true or false

A

FALSE- small bowel cancer is rare

60
Q

State the 5 different types of small bowel cancer

A
  • Stromal
  • Lymphoma
  • Adenocarcinoma
  • Sarcoma
  • Carcinoid tumours
61
Q

State some risk factors for small bowel cancer

A
  • IBD
  • Coeliac disease
  • FAP (familial adenomatous polyposis)
  • Diet
62
Q

State some symptoms of small bowel cancer

A
  • Weight loss
  • Abdominal pain
  • Blood in stools
63
Q

Recap TNM staging

A

Most common method of staging extent of a tumour; standardised across world for various cancers but each cancer has own specific TNM criteria:

  • T: size of primary tumour (T1-T4)
  • N: extension of regional node metastases via lymphatics (N0-N3)
  • M: extent of distant metastatic spread via blood (M0 or M1)
64
Q

Recap Duke’s staging

A

Duke’s staging used for colorectal carcinoma (but TNM is preferred world wide)

  • A: invasion into but not through bowel wall
  • B: invasion through bowel wall
  • C: involvement of lymph nodes
  • D: distant metastases
65
Q

Describe the general management of cancers

A
  • Staging
  • Blood test- FBC, tumour markers (CEA, CA 19-9)
  • CT/MRI
  • Endoscopy/colonoscopy/capsule endoscopy
  • Treatment:
    • Chemotherapy
    • Radiotherapy
    • Surgical resections
66
Q

Dysphagia can be caused by extraluminal, luminal or intraluminal causes; describe each and give an example

A
  • Extraluminal: something outside GI tract compressing oesophagus e.g. tumour of lungs
  • Luminal: something wrong with tube itself e.g. stenosis
  • Intraluminal: something stuck in lumen e.g. foreign object
67
Q

State 2 risk factors for oesophageal carcinoma

A
  • Smoking
  • Barett’s oesophagus
68
Q

State 4 common causes of upper GI bleeding

A

Ones in green

69
Q

Chronic inflammation increases risk of malignancy; true or false

A

True

70
Q

State some malignancies that commonly metastasise to liver

A
  • Lung cancer
  • Breast cancer
  • Renal cancer
  • Prostrate cancer
71
Q

Is there any screening for large bowel cancer?

A

YES- very sucessful:

  • Faecal occult blood samples
72
Q

Which, out of left sided colon cancer and right sided colon cancer, is often detected earlier?

A

Left sided colon cancers detected earlier than right sided colon cancers generally

73
Q

What is this sign called?

A

Apple core sign

74
Q

State2 tumour markers and which cancers they are indicative of

A

CEA- bowel cancer

CA 19-9- pancreatic cancer

S3: Gastrointestinal (18 decks)

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