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Yr 5 GI & Breast > Cancer > Flashcards

Cancer Flashcards

1
Q

How common is colorectal cancer?

A

3rd most common cancer

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2
Q

How does colorectal cancer occur?

A

normal epithelium → hyper proliferative epithelium → benign adenoma → invasive carcinoma (spreads by local invasion, lymph or coelomic spread)

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3
Q

What is the most common type of colorectal cancer? What are the other types?

A

Adenocarcinoma 95%
Carcinoid
GI Stromal
Primary malignant lymphoma

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4
Q

Where is colorectal cancer most commonly found?

A

Rectum-40%
Sigmoid-20%
Caecum- majority develop from polyps

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5
Q

What are the risk factors for colorectal cancer?

A

Western diet
Familial: HNPCC, FAP, Gardner’s, Peutz-Jahger
Mutations: P53, RAS

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6
Q

What are the typical features of colorectal cancer?

A

Altered bowel habits
Weight loss
Rectal bleeding
Vague abdo pain

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7
Q

What are the Sx of a RHS cancer?

A

Occult bleeding
Mass in RIF
MORE ADVANCED AT PRESENTATION

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8
Q

What are the Sx of a LHS Cancer?

A 
Obstruction & Tenesmus
Rectal bleeding (fresh blood)
Colicky abdo pain
Mass in LIF
LESS ADVANCED AT PRESENTATION
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9
Q

What criteria needs to be met for a 2week referral for ?colorectal carcinoma?

A

Abdo mass
>40yo w/↓weight + abdo pain
>50yo w/rectal bleeding
>60yo w/Fe+ anaemia OR altered bowel habits
<50yo w/rectal bleeding AND 1 of: Abdo pain/bowel change/↓weight/Fe anaemia

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10
Q

What is the screening process for colorectal cancer?

A

Faecal occult blood
60-70yo every 2years
Abnormal → Colonoscopy
Sigmoidoscopy if 55yo as a one off

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11
Q

How is colorectal cancer investigated?

A

1) DRE (75% rectal lesions detected) & Bloods
2) Scope & biopsy: Sigmoid if <25cm or colonoscopy = GOLD STANDARD
3) CT- staging

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12
Q

How is colorectal cancer managed?

A

1) Surgery: Radical resection, palliative = stent
2) RT = 1st line for rectal cancers
3) Chemo: 5-FU
4) Cetuximab: Targets EGFR, can cause painful rash

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13
Q

What staging is used for colorectal cancers?

A 
Duke's staging
A: Tumour confined to mucosa
B: Into muscularis propria
C: Spread to regional lymph nodes
D: Distal mets
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14
Q

What is the prognosis for colorectal cancers in relation to Duke’s staging?

A 
A = 80%
B = 50%
C = 40-15%
D = 5%
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15
Q

Where does colorectal cancer commonly metastasize to?

A

Liver

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16
Q

Describe an ileostomy

A

Often for bowel resection
Liquid- unformed faeces
RIF
Spout to skin

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17
Q

Describe a colostomy

A 
Single loop- removal of sigmoid segment
Loop- Anastomosis to allow surgery to heal
Solid faeces
LIF
Flush to skin
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18
Q

What are the complications of stomas

A 
FOUL SHITS
F: Fluid loss
O: Odour
U: Ulcers
L: Leakage
S: Stenosis
H: Hernia
I: Ischaemia
T: Terminal ileum loss (↓B12)
S: Sexual issues
19
Q

What is the most common inherited cause of colonic cancer?

A

HNPCC aka Lynch Syndrome

20
Q

What is Lynch Syndrome?

A

Autosomal Dominant
MSH2 or MLH1
Mutation of DNA mismatch repair genes

21
Q

In which location in the bowel is Lynch syndrome most commonly seen?

A

Right sided proximal colon- poor differentiation & highly aggressive
Also endometrial cancer

22
Q

What are the investigations for HNPCC?

A

Colonoscopy every 1-2years from 25yo

Amsterdam Criteria- Aid diagnosis

23
Q

How is HNPCC treated?

A

Surgery

24
Q

What is FAP?

A

Autosomal dominant mutation in TSG leading to hundreds of adenomatous polyps

25
Q

What does Gardner’s syndrome cause?

A

Osteomas of the skull/mandible
Retinal pigmentation
Thyroid Ca
Epidermal cysts on skin

26
Q

How is FAP investigated?

A

Annual flexible sigmoidoscopy from 15yo
No polyps = 5yearly colonoscopy started at 20yo
Amsterdam Criteria- Aid diagnosis

27
Q

How is FAP managed?

A

Total colectomy + ileo-anal pouch formation

28
Q

What is Peutz-Jagher?

A

Multiple benign intestinal harmatomas

Autosomal dominant mutation of STK11

29
Q

How does Peutz-Jagher present?

A

Episodic obstruction
Intussusception
Pigmented lesions on lips, oral mucosa, face, palms, soles

30
Q

How is Peutz-Jagher investigated?

A

Annual exam

Pan-intestinal endoscopy 2-3years

31
Q

What are the risk factors for gastric cancer?

A 
↑Age 
Male
H.Pylori
Diet: Low in fruit + veg
Smoking
Gastritis
Pernicious anaemia
32
Q

What are the clinical features of a gastric cancer?

A

ALARMS

33
Q

How is a gastric cancer investigated?

A

2week endoscopy- Biopsy & histology
Bloods: FBC, LFTs
CT/EUS- Staging

34
Q

What may histology show in gastric cancer?

A

Signet ring cells- higher number = poor prognosis

35
Q

How is gastric cancer managed?

A

Gastrectomy

Chemo/RT

36
Q

What are the types of liver tumours?

A

Hepatocellular carcinoma 90%

Cholangiocarcinoma

37
Q

What are the majority of liver cancers- primary or secondary?

A

Secondary mets from breast, bronchus, GI tract

38
Q

What are the risk factors for a hepatocellular carcinoma?

A 
Primary biliary Cirrhosis!!
OH-
Haemochromotosis
A1-Antitrypsin
DM
Hepatitis
39
Q

What tumour marker is raised in hepatocellular carcinoma?

A

↑AFP

40
Q

If ↑AFP what MUST be checked?

A

CHECK FOR TESTICULAR CANCER

41
Q

What are the causes of cholangiocarcinoma?

A

Primary sclerosis cholangitis
Flukes
N-nitrosamines

42
Q

What do the LFTs show for someone with cholangiocarcinoma?

A

↑↑ALP ↑AST/ALT ↑Bil 2

↑CEA ± ↑CA19-9, CA125

43
Q

How are hepatocellular carcinoma and cholangiocarcinoma treated?

A

Surgical resection- Curative

Yr 5 GI & Breast (13 decks)

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