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xB15W3 > CANCER OF THE GI TRACT > Flashcards

CANCER OF THE GI TRACT Flashcards

1
Q

whats the first and second most common causes of cancer death?

A

lung cancer 23%

colorectal 8%

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2
Q

how many bowel cancers are diagnosed at a late stage?

A

> 50%

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3
Q

what is overt bleeding?

A

bleeding that is visible to the patient or clinician

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4
Q

what is occult bleeding?

A

gastrointestinal bleeding that is not visible to the patient or physician

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5
Q

what type of pain will bowel cancer present with?

A

visceral/poorly localised/central related to the area of the tumour e.g. foregut causes epigastric pain

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6
Q

what are 2 types of oesophageal cancer?

which is most common?

A

squamous cell carcinomas - most common

adenocarcinomas

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7
Q

where will squamous cell vs adenocarcinomas be found in oesophageal cancer?

A

squamous cell in upper 2/3rds and adenocarcinomas in lower 1/3rd of the oesophagus

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8
Q

what is squamous cell oesophageal carcinoma strongly associated to?

A 
alcohol
smoking
and less commonly...
hot beverages
radiation to the mediastinum
caustic strictures 
diet deficient in fruit and veg
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9
Q

where are the highest rates of squamous cell oesophageal cancer?

A

Iran
China
Brazil
South Africa

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10
Q

where are the higher rates of oesophageal adenocarcinoma?

A

western countries

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11
Q

what is oesophageal adenocarcinoma strongly associated with?

A

Barrett’s oesophagus

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12
Q

what is barretts oesophagus?

A

when chronic acid reflux causes intestinal metaplasia i.e. squamous epithelium is replaced by columnar epithelium that is better to withstand acidity

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13
Q

how can barretts oesophagus lead to oesophageal adenocarcinomas?

A

mutations can occur as the cell types change and these mutations can occur in tumour suppressor genes or proton oncogenes leading to adenocarcinoma

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14
Q

what age does oesophageal cancer usually occur?

A

70+

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15
Q

what is the typical presentation of oesophageal cancer?

A

progressive dysphagia and odynophagia epigastric pain, progressive weight loss , haematemesis

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16
Q

why does oesophageal cancer have a poor prognosis?

A

because by the time a patient is symptomatic it has usually already metastasised
also surgery is required for treatment but its usually on the elderly which has higher risks
oesophagus is harder to reach surgically too

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17
Q

when you diagnose oesophageal cancer, why should you also check for simultaneous head/neck/lung cancers?

A

as these conditions all share the same risk factors

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18
Q

whats the 5 year survival prognosis for oesophageal cancer?

A

20% or less

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19
Q

what are the 4 types of gastric cancer?

A 
primary gastric lymphoma
adenocarcinoma
neuroendocrine tumours e.g. G cells
gastrointestinal stromal tumor 
leiomyosarcoma
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20
Q

whats the most common type of gastric cancer?

A

adenocarcinoma

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21
Q

what are the 2 types of adenocarcinoma?

A

intestinal type - most common

and diffuse infiltrative type

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22
Q

outline the pathophysiology of the intestinal type of gastric adenocarcinoma?

A

increase signalling in Wnt pathway which causes decreased adenomatous polyposis coli gene and increased beta catenin

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23
Q

what infection is gastric cancer associated with?

A

H.pylori

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24
Q

whats the precursor lesion of the intestinal type of gastric adenocarcinoma?

A

adenomas

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25
outline the pathophysiology of the diffuse type of gastric adenocarcinoma?
the tumour penetrates the connective tissue in the stomach wall where it causes the desmoplastic reaction = fibrosis of the wall this is known as 'leather bottle stomach' The key step is the CDH1 mutations = loss of E.cadherin
26
where is gastric cancer high in incidence?
Eastern Europe and Japan
27
why are the rates of gastric cancer decreasing in hr Western world?
decreased H/pylori prevalence | eating less salt and smoked food
28
what age does gastric cancer typically present?
50-60s
29
what are some risk factors for gastric cancer?
``` GERD obesity diet high in salt/smoked foods diet low in fruit and veg Fhx H.pylori infection gastritis smoking ```
30
what are some protective factors for gastric cancer?
high intake of fruit, veg, fibre and folate
31
how does gastric cancer present?
starts of presenting like chronic gastritis with dyspepsia, dysphagia and nausea it progresses to weight loss, anorexia, early satiety, harmorrhage
32
what are some paraneoplastic syndromes for gastric cancer?
seborrheic keratosis (leser trelat sign), polyarteritis nodosa, trousseau syndrome, pseudoachalasia syndrome
33
whats the 5 year prognosis for gastric cancer?
<30%
34
what age does pancreatic cancer typically affect?
60-80s
35
what are the risk factors for pancreatic cancer?
``` smoking - strongest obesity diet high in red meat male Fhx African-American >65 diabetes chronic pancreatitis liver cirrhosis ```
36
whats are most pancreatic tumours?
adenocarcinomas in the exocrine tissue, at the head
37
what type of pancreatic exocrine gland carcinomas are there?
adenocardinoma acing cell carcinoma cystadenocarcinomas
38
what are the precursor lesions of pancreatic cancer?
intraepithelial neoplasia
39
what genes are associated with pancreatic cancer?
KRAS oncogene | CDKN2A tumour suppressor gene
40
whats the presentation of pancreatic cancer?
``` epigastric pain worse on lying flat on back jaundice courvoisiters sign weight loss and anorexia migratory thrombophlebitis ```
41
whats the only treatment for pancreatitis? what percentage of patients can have this?
surgery | <10%
42
what are the survival rates for pancreatic cancer?
<5%
43
where is colorectal cancer incidence the largest? why?
Western countries | siet poor in veg fibre and high in refined fats and carbs
44
what are risk factors for colorectal cancer?
Lack of regular physical activity. A diet low in fruit and vegetables. A low-fiber and high-fat diet, or a diet high in processed meats. Overweight and obesity. Alcohol consumption. Tobacco use. and hereditary nonpolyposis/Lynch syndrome 1
45
why is colorectal cancer suitable for screening?
as it usually begins with a benign polyp 3-5 years earlier
46
what are the classic symptoms of colorectal cancer?
changes in bowel habits pain bleeding tenesmus
47
which sided colorectal cancer will present as silent anaemia?
right sided
48
what is the underlying cause of iron deficiency in an older male/postmenopausal female until proven otherwise?
bowel cancer
49
whats the difference in symptoms with ascending vs descending colorectal cancer?
ascending doesnt cause bowel obstruction like descending does with causes napkin-ring constriction so descending gets colicky abdo pain
50
whats the sign of colorectal cancer on a barium enema?
apple core sign - constriction of the lumen which is most often in the descending arm
51
whats an adenoma?
a polyp made up of tissue that looks much like the normal lining of your colon
52
what is familial adenomatous polyposis?
an autosomal dominant condition that affects the gastrointestinal tract. FAP leads to over one hundred polyps inside the colon or rectum.
53
what is the main causes of colorectal adenocarcinomas?
sporadic changes in the Wnt pathway
54
what is hereditary non-polyposis colorectal cancer/Lynch syndrome?
an autosomal dominant condition that increases your chance of colorectal cancer
55
which gene is usually involved in the start of colorectal cancer?
Adenomatous polyposis coli gene
56
what proportion of western adults over 30 get neoplastic polyps?
30%
57
whats a polyp?
a projecting growth of tissue from a surface in the body, usually a mucous membrane
58
outline surveillance for colorectal cancer?
colonoscopy is recommended for people over 50, especially if there is a family history. Fecal occult blood tests can also be done.
59
outline the TNM staging for colorectal cancer?
stage 1 - carcinoma in situ stage 2 - tumour invades submucosa and muscular propria stage 3 -lymph node invasion stage 4 - metastasis
60
whats the onyl curative treatment for colorectal cancer?
surgery
61
whats the main cause of death of colorectal cancer?
the metastasis
62
whats the overall 5 year survival rate for colorectal cancer?
50%

xB15W3 (8 decks)

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