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Alimentary System > Cancers of the alimentary system > Flashcards

Cancers of the alimentary system Flashcards

1
Q

Give two histological types of oesophageal cancer and where they occur

A

squamous cell carcinoma
- proximal and middle thirds of oesophagus
adenocarcinoma
- distal third of oesophagus

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2
Q

Describe the symptoms which may be associated with oesophageal cancer

A 
Progressive dysphagia
Vomiting (may have blood in vomit)
Weight loss/anorexia
Malaena/Haematemesis
Lymphadenopathy
Odynophagia
Hoarseness
Retrosternal pain
Cough
Vocal cord paralysis
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3
Q

Why does oesophageal cancer generally have a poor prognosis?

A

Usually presents late; tumours have often spread to regional lymph nodes and/or liver by the time the symptoms occur

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4
Q

Why is oesophageal cancer often inoperable?

A

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

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5
Q

Where are the most common sites of metastasis in oesophageal cancer?

A

Liver
Brain
Lung
Bone

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6
Q

Which type of oesophageal cancer is associated with Barrett’s oesophagus?

A

Adenocarcinoma

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7
Q

Describe the initial investigations for a patient presenting with symptoms of oesophageal cancer

A 
FBC
U&E
LFT
Blood glucose
CRP
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8
Q

How is oesophageal cancer diagnosed? What tests are used to determine stage?

A

Diagnosis: endoscopy and biopsy
Staging: CXR, CT, PET, bone scan, endoscopic ultrasound, FNA of lymph nodes

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9
Q

Describe T-staging of oesophageal cancer

A 
Tis = carcinoma in situ
T1 = invasion of lamina propria / submucosa
T2 = invasion of muscularis externa
T3 = invasion of adventitia
T4 = invasion of adjacent structures
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10
Q

What symptom palliation is often given to oesophageal cancer patients?

A

Dysphagia is main symptom treated
- endoscopic stent
chemo/radiotherapy
brachytherapy

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11
Q

What is the most common type of gastric cancer?

A

adenocarinoma (epithelial cells)

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12
Q

Which organ is gastric cancer most likely to invade? What route would the cells take?

A

The liver, via the blood

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13
Q

What is meant by “transcoelomic spread”?

A

Spread (of cancer cells) within the peritoneal cavity

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14
Q

Give two surgical procedures that might be used to treat gastric cancer

A

Subtotal gasrectomy

Total gastrectomy and roux en y reconstruction

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15
Q

Which symptoms is it most important to manage in gastric cancer?

A

Pain, nausea, constipation

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16
Q

What is the most common type of pancreatic cancer?

A

Duct cell mucinous adenocarcinoma (affects exocrine tissue)

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17
Q

Give four pathological types of pancreatic cancer

A

Duct cell mucinous adenocarcinoma
Carcinosarcoma
Cystadenocarcinoma
Cancer of the acinar cells

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18
Q

Describe the symptoms that may be caused by pancreatic cancer

A 
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
19
Q

What is thrombophlebitis migrans?

A

Vein inflammation occurring in multiple locations

- sign of malignancy

20
Q

Describe the signs that may be caused by pancreatic cancer

A 
Hepatomegaly
Jaundice
Abdominal mass and/or tenderness
Ascites
Splenomegaly
Supraclavicular lymphadenopathy
Palpable gallbladder
21
Q

How might pancreatic cancer cause the gallbladder to become palpable?

A

If the cancer is in the ampulla (ampullary carcinoma)

22
Q

What investigations would be done for a patient with suspected pancreatic cancer?

A

Abdominal ultrasound
CT/MRI scan
Endoscopic ultrasound (with biopsy)
Percutaneous needle biopsy

23
Q

What proportion of pancreatic cancers are operable?

A

less than 10%

24
Q

What are the requirements for a patient to be suitable for surgery to resect pancreatic cancer?

A

Patient must be fit for the surgery
Tumour less than 3cm diameter
No metastases

25
Q

How can pancreatic cancer cause upper abdominal pain?

A

If the cancer infiltrates the coeliac plexus

26
Q

What are the options for pain control for patients with pancreatic cancer?

A

Opiates
Coeliac plexus block
Radiotherapy

27
Q

What are polyps?

A

Small growths in the colon, can be adenomatous

- benign tumour of epithelial tissue with glandular origin

28
Q

Give three histological types of adenomatous polyp

A

Tubular
Tubulovillous
Villous

29
Q

What dietary factors are thought to increase risk of developing polyps?

A

High in red meat
High fat
Low fibre

30
Q

What is the most common type of colorectal cancer?

A

Adenocarcinoma

31
Q

Give three common symptoms of colorectal cancer that are usually present regardless of cancer location

A

Rectal bleeding
Persisting change in bowel habit
Anaemia

32
Q

What symptoms are associated with right colon cancers?

A

Weight loss
Anaemia
Occult bleeding
Mass in right iliac fossa

33
Q

What symptoms are associated with left colon cancers?

A 
Colicky pain
Rectal bleeding
Bowel obstruction / tenesmus
Mass in left iliac fossa
Early change in bowel habit
34
Q

What is the main treatment for localised colorectal cancer?

A

Surgery

Radiotherapy and chemotherapy can improve survival rates after surgery

35
Q

What investigations may be done for a patient with suspected colorectal cancer?

A 
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
36
Q

What is the most common type of anal cancer?

A

Squamous cell carcinoma

37
Q

Give four types of anal cancer

A

Squamous cell carcinoma
Melanoma
Lymphoma
Adenocarcinoma

38
Q

Describe the risk factors for anorectal cancer

A 
Human papillomavirus (HPV)
Anal sex (therefore more common in homosexual men)
Immunocompromised patients
 - HIV
 - immunosuppressant drugs
Smoking
Previous malignancy
39
Q

How does anorectal cancer commonly present?

A

Peri-anal pain and bleeding
Palpable lesion
Faecal incontinence

40
Q

What investigations would be done for a patient with suspected anorectal cancer?

A 
Biopsy of any suspicious lesions
Rectal examination (under anaesthesia)
CT/MRI scan
Endo-anal ultrasound
PET scan
Tests for relevant infections
41
Q

How is anorectal cancer managed?

A

Mainly radiotherapy

Chemotherapy can be combined with radiotherapy

42
Q

When might anorectal cancer require surgery?

A

Tumour fails to respond to radiotherapy
Tumour is large enough that it is causing GI obstruction
Small anal margin tumours without sphincter involvement

43
Q

What are the potential complications of treating anorectal cancer with radiotherapy?

A

Anal ulcers
Anal stenosis
Necrosis

44
Q

What risk factors are there for oesophageal cancer?

A

Achalasia
GORD
Alcohol
Coeliac disease

Alimentary System (24 decks)

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