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alimentary disease Flashcards

gastrointestinal cancer: list the common cancers of the gastrointestinal system (oesophageal, pancreatic & colon), recall associated cell types, explain clinical features, investigations, treatments and risk of malnutrition

1
Q

feature of primary cancers

A

arise directly from cells in organ e.g. bowel cancer

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2
Q

feature of secondary cancers

A

spread from another organ, directly of by other means (blood or lymph) e.g. liver cancer

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3
Q

locations of GI cancers

A

oesophagus, stomach, biliary system, pancreatic, colorectal (small intestine, large intestine, colon, anus)

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4
Q

2 types of oesophageal cancer

A

adenocarcinoma (most common), squamous cell carcinoma

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5
Q

features of adenocarcinoma (cell, location, related to, developed world)

A

from metaplastic columnar epithelium, lower 1/3 oesophagus, related to acid reflux, more developed world

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6
Q

what else are adenocarcinomas associated with

A

obesity, smoking, alcohol, males

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7
Q

development of adenocarcinoma

A

normal epithelium → hyperplasia → adenomatous polyps → adenocarcinoma → metastasis

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8
Q

features of squamous cell carcinoma (cell, location, pathway, developed world)

A

normal oesophageal squamous epithelium, upper 2/3s oesophagus, acetaldehyde pathway, less developed world

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9
Q

main causes of squamous cell carcinoma

A

smoking, alcohol, ingestic caustic substances

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10
Q

why is there a link of squamous cell carcinoma with alcohol and which population does it affect most

A

due to acetaldehyde metabolite, which damages epithelial cells; more common in Asians due to muations in acetalydehyde dehydrogenase

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11
Q

development of squamous cell carcinoma

A

normal epithelium → metaplasia → dysplasia → severe dysplasia → development of squamous cell carcinoma → metastisis

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12
Q

3 early symptoms of squamous cell carcinoma

A

difficulty and pain when swallowing, weight loss due to lack of nutrition, pain in breast bone and stomach, or feeling of reflux

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13
Q

2 later symptoms of squamous cell carcinoma

A

nausea, vomiting and regurgitation of food, vomiting blood due to trauma of tumour

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14
Q

3 clinical investigations of squamous cell carcinoma

A

endoscopy, CT scan (check for metastasis), endoscopic ultrasound (determine level of invasion)

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15
Q

2 treatments for squamous cell carcinoma

A

surgery (early can remove tumour, late must remove part of oesophagus, chemotherapy and radiotherapy

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16
Q

5 investigations for colon cancer

A

x-ray, CT, barium enema, colonoscopy, CT virtual colonoscopy

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17
Q

8 risk factors for colorectal cancer

A

family history, inflammatory bowel disease (Crohns, ulcerative colitis), familial adenomatous polyposis, hereditary non-polposis colon, Lynch syndrome, uncontrolled ulcerative colitis, age, previous polyps

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18
Q

early symptoms of pancreatic cancer

A

depression, abdominal pain and glucose intolerance

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19
Q

advanced symptoms of pancreatic cancer

A

weight loss, jaundice, ascites and gall bladder obstructions

20
Q

5 risk factors of pancreatic cancer

A

smoking, drinking, obesity, family, multiple endocrine neoplasia

21
Q

where does colorectal cancer occur

A

colon or rectum

22
Q

main causes of colorectal cancer

A

old age, lifestyle factors including diet (link to consumption of red meat and processed meat), alcohol, obesity, tobacco smoking, lack of physical activity

23
Q

screening of colorectal cancer

A

faecal sample testing for presence of blood

24
Q

locations of colorectal cancer with % frequency

A

caecum (19%), ascending colon (17%), transverse colon (11%), descending colon (6%), sigmoid colon (22%), rectum (25%)

25
Q

7 symptoms of colorectal cancer

A

worsening constipation, blood in stool (can be associated with many other disorders), loss of appetite, loss of weight, nausea and vomiting, rectal bleeding, anaemia, acute intestinal obstruction

26
Q

2 treatments for colorectal cancer

A

surgery (removal of tumour via colonscopy or laparotomy, which may cause colostomy), chemotherapy and radiotherapy

27
Q

epithelial cells and associated cancer

A

squamous (squamous cell carcinoma), glandular epithelium (adenocarcinoma)

28
Q

neuroendocrine cells and associated cancer

A

enterochromaffin (carcinoid tumours), interstitial cells of Cajal (GI stromal tumours)

29
Q

connective tissue and associated cancer

A

smooth muscle (leiomyoma or leiomyosarcomas), adipose (lipomas)

30
Q

causes of dysphagia in oesophageal cancer

A

achalasia (failure of oesophageal sphincter to release), obstruction

31
Q

why associated symptom of weight loss with oesophageal cancer

A

sicchasia and dysphagia

32
Q

progression from GERD (gastro-oesophageal reflux disease) to cancer

A

oesophagitis (inflammation) → Barrett’s oesophagus (metaplasia: squamous to columnar) → dysplasia → carcinoma (neoplasia)

33
Q

progression from normal epithelium to colon carcinoma

A

normal epithelium → hyperproliferative epithelium (aberrant cryptic foci with COX-2 overexpression) → small adenoma → large adenoma → colon carcinoma

34
Q

what can influence normal epithelium to hyperproliferative epithelium

A

aspirin, other NSAIDs, folate Ca2+

35
Q

what can influence hyperproliferative epithelium to small adenoma

A

aspirin, other NSAIDs

36
Q

what can influence small adenoma to large adenoma

A

oestrogen, aspirin, other NSAIDs

37
Q

3 features of pathology of colorectal cancer

A

not monogenic; sequence of genetic errors; inheritance so not simple Mendelian

38
Q

colorectal cancer: advantages and disadvantages of abdominal x-ray

A

cheap, easy, quick; not sensitive or specific for obstruction

39
Q

colorectal cancer: advantages and disadvantages of plain CT

A

quick, easy, see large lesions; may miss smaller lesions, no tissue, no therapy

40
Q

colorectal cancer: advantages and disadvantages of barium enema

A

reasonable sensitivity and specificity; time intensive, technically demanding, unacceprable to patients

41
Q

colorectal cancer: advantages and disadvantages of colonoscopy

A

safe, relatively quick, high sensitivity, able to obtain tissue; take bowel prep which causes 2 days of iatrogenic diarrhoea, small risk of perforation, risk of dehydration

42
Q

features of virtual CT

A

modified bowel prep so stool is “tagged” using Bismuth; computer aided subtraction of faeces to create images

43
Q

colorectal cancer: advantages and disadvantages of virtual CT

A

quick, easy, reduced bowel prep more tolerable, as good as colonoscopy for lesions >6mm; unable to obtain tissue or remove lesions

44
Q

symptoms of pancreatic cancer

A

non specific symptoms (Virchow’s triad: 70% pain, 10% anorexia, 10% weight loss)

45
Q

jaundice caused by pancreatic cancer

A

post-hepatic due to tumour obstruction

LSS Alimentary System (40 decks)

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