Cancers of the GI Tract Flashcards
76-yr-old gentleman presents to GP complains of discomfort behind his sternum every time he eats, starts seconds after swallowing. He noticed this 3 months ago and it’s getting worse.
• As a result, he has been eating less and less. His wife, who comes to the clinic with him, says he has lost a lot of weight, although he has not noticed.
• He denies any other symptoms
No shortness of breath, palpitations, vomiting, change in bowel habit or blood in stool.
• He’s an ex-smoker (20 pack-years) with a history of mild chronic obstructive pulmonary disease, hypertension (takes one tablet) and type 2 diabetes (diet-controlled).
Examination
• Slender Caucasian, sunken cheeks – weight loss.
• HR 88, regular pulse, BP 102/70
• Dry mucous membranes – dehydration
• Jugular venous pulse not visualised
• Chest – Right basal crepitations (COPD), heart sound normal
• Abdominal examination is unremarkable – no palpable masses or organomegaly.
What is the most likely diagnosis?
Adenocarcinoma
What are the causes of upper dysphagia?
- Structural causes: Pharyngeal cancer, pharyngeal pouch
* Neurological cause: Parkinson’s, stroke, motor neuron disease
What are the structural causes of upper dysphagia?
Pharyngeal cancer, pharyngeal pouch
What are the neurological causes of upper dysphagia?
Parkinson’s, stroke, motor neuron disease
What is odynophagia?
Food painful upon swallowing
What are the structural causes of lower dysphagia?
Inside structural cause (mural or luminal)
• Oesophageal or gastric cancer- distorts oesophageal patency.
• Stricture – Query history of reflux.
• Schatzki ring – Thickening of the mucosa (circular band), narrowing the lumen of the oesophagus.
What is Schatzki ring?
Thickening of the mucosa (circular band), narrowing the lumen of the oesophagus.
What are the neurological causes lower dysphagia?
Achalasia, diffuse oesophageal spasm.
What are the cardiac causes of lower dysphagia?
- Blood shifts to bowel for digestion, limiting blood supply through narrowed coronary arteries – hypoperfusion of cardiac muscle.
- Unusual for angina to occur exclusively after eating – explore exertional chest pain.
What is aspiration pneumonia?
• Aspiration pneumonia- regurgitated of food and is aspirated through the right primary bronchus.
What type of imaging is conducted to diagnose a patient with an adenocarcinoma?
PET/CT scan
The endoscopy reveals the internal lumen of the oesophagus to be constricted by an adenocarcinoma that extends outwards towards the wall.
• PET scan, sagittal view – the oesophageal lesion is bright suggesting regions of excessive metabolic activity – due to presence of cancer cells.
• Bright spot suggests lymph node involvement – therefore N1
• T3N1M0 (Extends to the adventitia, however, does not invade other tissues).
What is a 0 performance status?
Asymptomatic, and fully active
What is PS1?
Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature
What PS2?
Ambulatory and capable of all self-care but unable to carry out any work activities, up and about more than 50% of walking hours
What is PS3?
Capable of only limited self-care, confined to bed on chair more than 50% of waking hours
What is PS4?
Completely disabled, cannot carry on any self-care self-care.
What are the common causes of microcytic anaemia?
Iron deficiency anaemia
Anemia of chronic disease
Thalssemia
Sideroblastic anaemia
What are the common causes of normocytic anaemia?
Aplastic anaemia Bleeding Chronic disease Haemolysis Endocrine disorder- hypothyroidism, and hypoadrenalism
What are the common causes of macrocytic anaemia?
Foetus (pregnancy) Alcohol excess Thyroid disorders Reticulocytosis B12/Folate deficiency Cirrhosis.
FAT RBC
How is iron deficiency anaemia caused, in terms of blood loss?
- Increased demand (growth, pregnancy)
* Decreased absorption
What are the GI causes of iron deficiency anaemia?
- Aspirin/NSAID use
- Colonic adenocarcinoma
- Gastric carcinoma
- Benign gastric ulcer
- Angiodysplasia Abnormal development of blood vessels within the gastrointestinal tract.
- Coeliac disease
- Gastrectomy (decreased absorption)
- H. pylori
What are the non-GI causes of iron deficiency anaemia?
- Menstruation
- Blood donation
- Haematuria (1% of iron deficiency anaemia)
- Epistaxis
What are the four main symptoms with colorectal cancer?
- Change in bowel habit
- Blood or mucous in stool
- Faecal incontinence
- Feeling of incomplete emptying of bowels (tenesmus)
What are the general symptoms of a malignancy?
Weight loss, anorexia, malaise
What are the specific symptoms of an Upper GI cancer?
Dysphagia and Dyspepsia
How is an adenocarcinoma diagnosed?
Colonoscopy and biopsy confirm adenocarcinoma of the descending colon – there is growth within the lumen of the bowel manifesting as blockage.
A urine dipstick will reveal a positive result in a patient with GI cancer how?
Haematuria
What autoantibody is implicated in coeliac disease?
Anti-TTG
What is the main surgical intervention for a GI cancer?
- The proximal bowel is dilated suggesting that there is partial obstruction of the bowel by tumour, fluid accumulation.
- Resect primary colonic tumour followed by neoadjuvant chemotherapy and then liver resection.
What is the palliative route for bowel cancer?
• Palliative route – stenting to open up the lumen of the bowel in order to alleviate the partial obstruction.
