Cancers of the alimentary system Flashcards
Give two histological types of oesophageal cancer and where they occur
squamous cell carcinoma
- proximal and middle thirds of oesophagus
adenocarcinoma
- distal third of oesophagus
Describe the symptoms which may be associated with oesophageal cancer
Progressive dysphagia Vomiting (may have blood in vomit) Weight loss/anorexia Malaena/Haematemesis Lymphadenopathy Odynophagia Hoarseness Retrosternal pain Cough Vocal cord paralysis
Why does oesophageal cancer generally have a poor prognosis?
Usually presents late; tumours have often spread to regional lymph nodes and/or liver by the time the symptoms occur
Why is oesophageal cancer often inoperable?
Cancer cells are likely to have invaded surrounding structures such as the heart, trachea, and aorta
- this is because there is no peritoneal lining in the mediastinum to prevent this invasion
Where are the most common sites of metastasis in oesophageal cancer?
Liver
Brain
Lung
Bone
Which type of oesophageal cancer is associated with Barrett’s oesophagus?
Adenocarcinoma
Describe the initial investigations for a patient presenting with symptoms of oesophageal cancer
FBC U&E LFT Blood glucose CRP
How is oesophageal cancer diagnosed? What tests are used to determine stage?
Diagnosis: endoscopy and biopsy
Staging: CXR, CT, PET, bone scan, endoscopic ultrasound, FNA of lymph nodes
Describe T-staging of oesophageal cancer
Tis = carcinoma in situ T1 = invasion of lamina propria / submucosa T2 = invasion of muscularis externa T3 = invasion of adventitia T4 = invasion of adjacent structures
What symptom palliation is often given to oesophageal cancer patients?
Dysphagia is main symptom treated
- endoscopic stent
chemo/radiotherapy
brachytherapy
What is the most common type of gastric cancer?
adenocarinoma (epithelial cells)
Which organ is gastric cancer most likely to invade? What route would the cells take?
The liver, via the blood
What is meant by “transcoelomic spread”?
Spread (of cancer cells) within the peritoneal cavity
Give two surgical procedures that might be used to treat gastric cancer
Subtotal gasrectomy
Total gastrectomy and roux en y reconstruction
Which symptoms is it most important to manage in gastric cancer?
Pain, nausea, constipation
What is the most common type of pancreatic cancer?
Duct cell mucinous adenocarcinoma (affects exocrine tissue)
Give four pathological types of pancreatic cancer
Duct cell mucinous adenocarcinoma
Carcinosarcoma
Cystadenocarcinoma
Cancer of the acinar cells
Describe the symptoms that may be caused by pancreatic cancer
Upper abdominal pain Painless obstructive jaundice Itch (due to peripheral bilirubin) Weight loss Anorexia Fatigue Nausea/vomiting Diarrhoea/steatorrhoea Tender subcutaneous fat nodules Thrombophlebitis migran Ascites Portal hypertension
What is thrombophlebitis migrans?
Vein inflammation occurring in multiple locations
- sign of malignancy
Describe the signs that may be caused by pancreatic cancer
Hepatomegaly Jaundice Abdominal mass and/or tenderness Ascites Splenomegaly Supraclavicular lymphadenopathy Palpable gallbladder
How might pancreatic cancer cause the gallbladder to become palpable?
If the cancer is in the ampulla (ampullary carcinoma)
What investigations would be done for a patient with suspected pancreatic cancer?
Abdominal ultrasound
CT/MRI scan
Endoscopic ultrasound (with biopsy)
Percutaneous needle biopsy
What proportion of pancreatic cancers are operable?
less than 10%
What are the requirements for a patient to be suitable for surgery to resect pancreatic cancer?
Patient must be fit for the surgery
Tumour less than 3cm diameter
No metastases
How can pancreatic cancer cause upper abdominal pain?
If the cancer infiltrates the coeliac plexus
What are the options for pain control for patients with pancreatic cancer?
Opiates
Coeliac plexus block
Radiotherapy
What are polyps?
Small growths in the colon, can be adenomatous
- benign tumour of epithelial tissue with glandular origin
Give three histological types of adenomatous polyp
Tubular
Tubulovillous
Villous
What dietary factors are thought to increase risk of developing polyps?
High in red meat
High fat
Low fibre
What is the most common type of colorectal cancer?
Adenocarcinoma
Give three common symptoms of colorectal cancer that are usually present regardless of cancer location
Rectal bleeding
Persisting change in bowel habit
Anaemia
What symptoms are associated with right colon cancers?
Weight loss
Anaemia
Occult bleeding
Mass in right iliac fossa
What symptoms are associated with left colon cancers?
Colicky pain Rectal bleeding Bowel obstruction / tenesmus Mass in left iliac fossa Early change in bowel habit
What is the main treatment for localised colorectal cancer?
Surgery
Radiotherapy and chemotherapy can improve survival rates after surgery
What investigations may be done for a patient with suspected colorectal cancer?
Colonoscopy with biopsy FBC and LFTs Barium enema (if caecum not visualised on colonoscopy) CT colonography Liver ultrasound and CT/MRI for staging PET scan for detecting recurrent cancer
What is the most common type of anal cancer?
Squamous cell carcinoma
Give four types of anal cancer
Squamous cell carcinoma
Melanoma
Lymphoma
Adenocarcinoma
Describe the risk factors for anorectal cancer
Human papillomavirus (HPV) Anal sex (therefore more common in homosexual men) Immunocompromised patients - HIV - immunosuppressant drugs Smoking Previous malignancy
How does anorectal cancer commonly present?
Peri-anal pain and bleeding
Palpable lesion
Faecal incontinence
What investigations would be done for a patient with suspected anorectal cancer?
Biopsy of any suspicious lesions Rectal examination (under anaesthesia) CT/MRI scan Endo-anal ultrasound PET scan Tests for relevant infections
How is anorectal cancer managed?
Mainly radiotherapy
Chemotherapy can be combined with radiotherapy
When might anorectal cancer require surgery?
Tumour fails to respond to radiotherapy
Tumour is large enough that it is causing GI obstruction
Small anal margin tumours without sphincter involvement
What are the potential complications of treating anorectal cancer with radiotherapy?
Anal ulcers
Anal stenosis
Necrosis
What risk factors are there for oesophageal cancer?
Achalasia
GORD
Alcohol
Coeliac disease
