Benign + malignant tumors of the intestine

Question 1

For malignant oesophageal tumors, where are the squamous cell tumors usually?

Answer 1

the middle third of the oesophagus

Question 2

What do adenocarcinomas arise from in the oesophagus?

Answer 2

Barrett’s metaplasia

smoking + obesity are also risk factors

(and they are usually in the lower third of the oesophagus)

Question 3

clinical features malignant oesophageal carcinoma

Answer 3

progressive dysphagia

weight loss

Question 4

Investigations for malignant oesophageal carcinoma

Answer 4

oesophagoscopy with biopsy

CT: extra-oesophageal disease?

Question 5

Mx oesophageal carcinoma

Answer 5

Poor prognosis 10% 5YSR

Surgical resection with pre-op chemo for localised tumors

Expandable metal stents can provide relief of dysphagia for palliative patients

Question 6

Gastric cancer associations

Answer 6

H. pylori

Smoking
Diets (lots of salt, little fruit + veg)
FH

Question 7

which part of the stomach do tumors normally occur and what cell type?

Answer 7

antrum

adenocarcinomas

Question 8

How does H.pylori lead to gastric carcinoma?

Answer 8

h. pylori –> chronic gastritis –> intestinal metaplasia –> dysplasia –> carcinoma

Question 9

Symptoms gastric cancer

Answer 9

Pain similar to peptic ulcer pain

More advanced disease: nausea, anorexia and weight loss

Question 10

Signs gastric cancer

Answer 10

epigastric mass

lymph node sometimes felt in supraclavicular fossa (Virchow’s node)

mets: ascites + hepatomegaly

Question 11

Ix gastric cancer

Answer 11

Initial: Gastroscopy + biopsy

Staging: CT, EUS (endoscopic ultrasound)

Question 12

Mx gastric cancer

Answer 12

Surgery if operable

Lymphadenectomy

Pre-op chemo

Question 13

What are the greatest risk factors for colorectal cancer?

Answer 13

1. increasing age

2. family history

Question 14

What is HNPCC

Answer 14

Hereditary nonpolyposis colorectal cancer

Accelerated progression from adenoma to CRC.
Onset in 4th decade

Question 15

What is familial adenomatous polyposis

Answer 15

Numerous colorectal polyps develop in teenage years –> cancer by 20s

Epithelial up regulation and adenoma

Increased risk of extracolonic malignancies

Question 16

Polyp

Answer 16

an abnormal growth of tissue projecting into the intestinal lumen from the normally flat mucosal surface

most polyps in the colon are adenocarcinomas

Question 17

colorectal cancer spread

Answer 17

by direct invasion through the bowel wall, later invasion of blood vessels + lymphatics, spread to the liver and lung

Question 18

Vogel-stein hypothesis colorectal cancer

Answer 18

hyper proliferation of mucosa
increasing size of polyp
5 x genetic mutations in growth

–> cancer!!!

Question 19

where are most colorectal tumors? and presentation

Answer 19

left side of the colon
retal bleeding + stenosis
increasing intestinal obstruction

Question 20

presentation of carcinoma of the caecum and ascending colon

Answer 20

iron deficiency anaemia (due to loss of blood from the bowel)

right iliac fossa mass

Question 21

Ix colorectal cancer

Answer 21

**Colonoscopy with biopsies

FBC: anaemia, liver function

Radiology, PET scan

Faecal occult blood tests: used in population screening studies

Question 22

Mx colorectal cancer

Answer 22

Surgical: tumor resection and end-to-end anastomosis of bowel

RT, CT

Question 23

Who do you screen for colon cancer?

Answer 23

high risk individuals

from family colon syndromes or with a 1st degree relative developing colon cancer aged

Question 24

what causes hepatocellular carcinoma? (HCC)

Answer 24

chronic liver disease

cirrhosis, particularly due to viral hepatitis

Question 25

clinical features HCC

Answer 25

weight loss, anorexia, fever, ascites and abd pain

focal lesion

Question 26

Ix HCC

Answer 26

US/CT shows large filing defects
Serum AFP (alpha-fetoprotein) may be raised

Biopsy if there is diagnostic doubt

Question 27

Mx HCC

Answer 27

surgical resection or liver transplantation

Question 28

Aetiology pancreatic carcinoma

Answer 28

Hereditary and environmental factors

chronic pancreatitis is also pre-malignant

Question 29

What symptoms does cancer affecting the head of the pancras or ampullae of Vater present with?

Answer 29

painless jaundice from obstruction of CBD, and weight loss

examination: jaundice with characteristic scratch marks + a distended palpable gallbladder

Question 30

Courvoisier’s law

Answer 30

if in a case of painless jaundice the gallbladder is palpable, the cause will not be gallstones

in gallstone disease CI and fibrosis prevent distension of the gallbladder

Question 31

How does cancer of the body or tail of the pancreas present?

Answer 31

abd pain, weight loss and anorexia

Question 32

Ix pancreatic cancer

Answer 32

US: dilated bile ducts and a mass lesion

MRI + EUS used for staging

Question 33

Mx pancreatic cancer

Answer 33

Surgical resection = the only hope of cure.
But few its have resectable disease at diagnosis

CT + RT

palliative Tx: endoscopic stenting across obstructed distal CBD to relieve obstructive jaundice

Question 34

Imaging shows a bile duct stricture, a hilar mass or multiple mets

Answer 34

cholanguicarcinoma, cancer of the bile ducts

Question 35

adenoma

Answer 35

benign tumour formed from glandular structures in epithelial tissue

Question 36

what does faecal occult blood test do?

Answer 36

helps to diagnose bleeding disorders of the gut