Cancer

Question 1

Cancer and types

Answer 1

Uncontrolled division of abnormal cells
Primary = directly from the cells of the organ
Secondary = spread from another organ directly or from blood/lymph (metastases)

Question 2

Locations of gastrointestinal cancers

Answer 2

Oesophageal

Stomach

Biliary system

Pancreatic

Colorectal (small/large intestines, colon, anus)

Question 3

Types of oesophageal cancers

Answer 3

Adenocarcinoma

> metaplastic columnar epithelium

> lower 1/3 of the oesophagus

> acid reflux relations and occurs more in the developed world

Squamous cell carcinoma

> normal oesophageal squamous epithelium

> upper 2/3 of the oesophagus

> acetaldehyde pathway and less developed world

Question 4

Colon cancer investigations

Answer 4

Abdominal radiography

Computer tomography (CT)

Barium enema

Colonoscopy

CT virtual colonoscopy

Question 5

Epidemiology of colon cancer

Answer 5

over 30,000 new cases every year

14% of cancers in men and 12% in women

1 in 25 lifetime risk

1 in 50 risk of death

Question 6

Risk factors for colon cancer

Answer 6

• Family history
• Inherited conditions (FAP, HNPCCM lynch syndrome)
• Uncontrolled ulcerative colitis
• Age
• Previous Polyps

Question 7

Symptoms of pancreatic cancer

Answer 7

Early

depression, abdominal pain, glucose intolerance

Advanced

weight loss, jaundice, ascites, gall bladder obstructions

Question 8

Epidemiology of pancreatic cancer

Answer 8

Poor outcome, 20% are suitable for resection

> surgery = curative = 20-25% of cases

> 1 year survival = 18%

> 5 year survival = 2%

‘Silent killer’ due to the diagnosis being given very late

Question 9

Pancreatic cancer risk factors

Answer 9

Smoking, drinking, obesity, family

Question 10

Outline the development of an oesophageal adenocarcinoma

Answer 10

1. normal epithelium
2. Hyperplasia = abnormal cell proliferation
3. Adenomatous polyps development
4. Adenocarcinoma development
5. Metastasis

Occurs 10 times more frequently in men than women (might be due to hormonal control in women0

Question 11

Outline the development of an oesophageal squamous cell carcinoma

Answer 11

1. Normal epithelium
2. Metaplasia - abnormal squamous cell development
3. Dysplasia - proliferation
4. Severe dysplasia - majority of cells are abnormal
5. Squamous cell carcinoma development
6. Metastasis

Question 12

Symptoms of oesophageal cancer

Answer 12

Difficulty/ pain when swallowing

Weight loss

Breast bone and stomach pains/ feelings of reflux

Later = nausea, vomiting (blood) might be due to trauma of the tumour

Symptoms may not show until 50% of the circumference of the oesophagus is cancerous due to tumour narrowing the tube

Question 13

Clinical investigations of oesophageal cancer

Answer 13

Endoscopy = camera to observe the tumour and a biopsy to evaluate the cellular histology

CT scan = check for metastasis

Endoscopic ultrasound = determine the level of invasion

Question 14

Treatment of oesophageal cancer

Answer 14

Surgery

> during the early stages the tumour may be removed from the oesophageal wall

>oesophagectomy - removal of part of the oesophagus

Chemotherapy and radiotherapy

Question 15

Symptoms of colorectal cancer

Answer 15

• Worsening constipation
• Blood in stool
• loss of appetite
• Nausea and vomiting
• Rectal bleeding
• Anaemia

Question 16

Treatment for colorectal cancer

Answer 16

Surgery

> removal of the tumour via colonoscopy/laparotomy

> removal of parts of the colon - colostomy

Chemotherapy ad radiotherapy