Cancer

Question 1

Incidence of GI cancers. (3)

Answer 1

Bowel cancer is 4th most common

5/ top 20 are GI - bowel, pancreas, oesophagus, stomach, liver.

Question 2

Describe three classifications of dysphagia. (3)

Answer 2

Extraluminal - external compression eg heart
Intralumial - things getting stuck
Luminal - benign or malignant growths

Question 3

Describe the red flags of dysphagia. (5)

Answer 3

Anaemia
Loss of weight
Anorexia
Recent onset of rapidly progressing symptoms
Masses / Malaena
Spells ALARM

Question 4

Describe the types of cancers found in the GI tract. (3)

Answer 4

Most are columnar - adenocarcinoma

Oesophagus is squamous - squamous cell carcinoma - unless Barrett’s oesophagus occurs to columnar - then adenocarcinoma.

Question 5

Describe the commonest cancer that presents with dysphagia. (3)

Answer 5

Oesophageal.
Severe and progressive dysphagia
Risk factors: smoking, Barrett’s.

Question 6

Give 5 causes of epigastric pain.

Answer 6

Peptic ulcers, pancreatitis, oesophageal varices, carcinoma,

Question 7

Describe Mallory-Weiss syndrome. (1)

Answer 7

Haematemesis from the friction of common vomiting.

Question 8

Describe gastric cancer. (7)

Answer 8

Adenocarcinoma typically in antrum or cardia. Presents similarly to peptic ulcers, often with a palpable mass.
Risk factors: smoking, FH, high salt diet, H pylori.
Survival poor unless screened for, but we don’t do that here.

Question 9

Describe gastric lymphoma. (3)

Answer 9

MALT tissue. Similar presentation to adenocarcinoma, but better prognosis. B
Heavily assocaited with H pylori.

Question 10

Describe GI stromal tumours (1)

Answer 10

Incidental finding of sarcoma.

Question 11

Describe the red flags associated with jaundice. (3)

Answer 11

Hepatomegaly with irregular border
Unintentional weight loss
Ascites

Question 12

Describe the primary malignancy of the liver. (2)

Answer 12

Hepatocellular carcinoma, assocaited with cirrhosis.

Question 13

Describe the secondary malignancy of the liver. (3)

Answer 13

Metastatic due to haematogenous spread through portal system. Breast, bowel, pancreas common.

Question 14

Describe pancreatic cancer. (5)

Answer 14

Head: jaundice
Body/tail: more vague - altered metabolism
Prognosis poor because detection hard.
Risk factors: FH, smoking, male, old, chronic pancreatitis.

Question 15

Describe obstruction as a key symptom that indicates distal GI malignancy. (6)

Answer 15

SI - nausea and vomiting
LI - constipation
Benign causes: volvulus, hernias, diverticular disease.
Red flags: unintentional weight loss, unexplained abdo pain.

Question 16

Describe PR bleeding as a key symptom that indicates distal GI malignancy. (9)

Answer 16

Haematochezia or malaena?
Benign: haemorrhoids, anal fissure, infective gastroenteritis, IBD, diverticular Disease.
Red flags: 50-60 years old, iron deficiency anaemia, unexplained weight loss, changes in bowel habit, tenesmus.

Question 17

Describe tenesmus. (2)

Answer 17

Rectal cancer giving the constant urge to deficate.

Question 18

Describe changes in bowel habit as a key symptom that indicates distal GI malignancy. (5)

Answer 18

Changes from normal FOR THE PATIENT
Benign: thyroid disorder, IBD, IBS, medications
Red flags: iron deficiency anaemia, PR blood loss, unexplained weight loss.

Question 19

Describe large bowel cancer. (5)

Answer 19

Adenocarcinoma
Risk factors: FH, IBD, polyposis syndromes (HNPCC and FAP), sedentary lifestyle, high fat diet.
Screening: fecal occult blood samples.

Question 20

Describe the differences between cancer of the right side of the colon (ascending) and the left sode (descending). (7)

Answer 20

Both present with weight loss and masses in the iliac fossa.
Right side: anaemia, occult bleeding, unlikely to become obstructed, late change in bowel habits, advanced at presentation.
Left side: rectal bleeding, tenesmus, obstruction, early changes in bowel habit, less advanced at presentation.

Question 21

Describe cancer of the small bowel. (10)

Answer 21

Rare
5 types: stromal, lymphoma, adenocarcinoma, sarcoma, carcinoid tumours.
Risk factors: IBD, coeliac disease, FAP, diet.
Symptoms: weight loss, abdo pain, bloody stools.

Question 22

Describe the diagnosis of GI cancers. (4)

Answer 22

Blood tests - anaemia, tumour markers
CT/MRI
Endoscopy / colonoscopy - got for everything but SI, can biopsy.
Capsule endoscopy - good to visualise SI but can’t biopsy.

Question 23

Describe the staging of GI cancers. (2)

Answer 23

TNM for most things

Duke’s staging for colorectal.

Question 24

Describe the treatments of GI cancers. (3)

Answer 24

Chemotherapy / new-aduvent chemo - reduces size for possible removal.
Radiotherapy - often palliative symptom reduction
Surgical resection.

Question 25

Describe Virchow’s node. (4)

Answer 25

The left supraclavicular lymph node that drains the abdomen meaning mets of the GI tract refer here along with ovarian and testicular.