CT 2.4 Intra-abdominal Cancer Flashcards
which form of intra-abdominal cancer is the most common
CRC is the most common and SI is the least common
after CRC is pancreatic, stomach cancer, liver + SI
seem to be more common in males than females
what blood test marker is used for CRC
CEA carcinoembryonic antigen
is a protein that can be sued as a tumour marker
- note it is non specific and can be raised in different malignancies
what tumour marker is used for pancreatic cancer
CA19.9 carbohydrate antigen
which tumour marker is used for hepatocellular carcinoma
AFP alpha fetoprotein
what is adjuvant treatment
Treatment given in addition to surgery.
To whom?
Those at increased risk of recurrence, local, regional, systemic.
Judged on tumour site, size, stage (clinical / pathological), microscopic differentiation.
Usually chemotherapy, occasionally radiotherapy or combination.
what are the most common cancers in the UK
breast
lung
prostate
CRC
melanoma
what are the mortality trends for different types of cancers
1 Lung cancer
2 CRC
3 prostate
4 breast
5 pancreatic
what is the distribution of colorectal cancers
2/3rd of colorectal cancers are found distal to the splenic flexure
how do bowel cancers spread
locally via the mucosa
through the bowel wall
invasion of adjacent structures
to local paracolic lymph nodes
to paraaortic lymph nodes
haematogenous to the liver, lung and bone
what is the relationship between polyps and colorectal cancer
the larger the polyp the more likely it is to be cancerous
How are cancers staged
TNM classification
T refers to the size of the tumour
can go up to T4
t1 = 0-2 cm in size
t2 = 2-5 cm in size
t3 = >5cm in size
t4 = has invaded local tissues
N refers to lymph node involvement
goes from N0 to N3
M refers to metastasis
M0 - no distant metastasis
M1 - distant metastasis
what are some ways to treat rectal cancer
total mesorectal excision (excision of cancer, some healthy rectum and the surrounding mesorectum)
whether a stoma is needed depends on the location of the cancer
if the cancer is lower down it is more probable you will need a permanent colostomy
with some surgical excisions stomas can be reversible and temporary
radiotherapy
what adjuvant treatment is shown to reduce the recurrence of rectal cancer alongside surgery
radiotherapy with surgery confers better outcomes in the years post surgery
what is the histological pattern of gastric cancer
90% are adenocarcinomas
squamous cell
GI stromal tumour - is a type of sarcoma found in wall of stomach
what are the risk factors for gastric cancer
h.pylori infection
smoked foods
tobacco and alcohol
pernicious anaemia and achlorhidria
blood group A
male
age - 50 to 70
presentation of gastric cancer
often late presentation
upper abdominal pain
weight loss
anaemia
anorexia - not wanting to eat
early satiety
N+V
what are the two types of oesophageal cancer
1) adenocarcinoma - associated with GORD, baretts oesophagus, smoking, obesity
[ affects the lower 1/3 of the oesophagus ]
2) Squamous cell carcinoma - linked to cured meats. fish etc, radiation to mediastinum, achalasia, plummer vinson syndrome
[ affects the upper 2/3 of the oesophagus]
what are the investigations for gastric cancer
FBC - anaemia, plasma proteins and malnutrition
endoscopy biopsy, CT chest and abdomen
what is plummer vinson syndrome
a triad of
dysphagia
glossitis
iron deficiency anaemia
what are the symptoms of oesophageal cancer
dysphagia
odynophagia
anorexia or weight loss
N+V
hoarseness
cough
haematemesis
melena
what is the gold standard for investigation and diagnosis
OGD and biopsy
what is a complication of surgery
anastomotic leak - if leakage occurs into thoracic cavity may lead to mediastinitis
In gastric cancer what nodes may be palpated in lymphatic spread
left supraclavicular virchows node
sister mary josephs nodes in the periumbilical area
to confirm a diagnosis of gastric cancer a OGD and biopsy is done. what cells may be present
signet ring cells (large clear area due to enlarged vacuole with nucleus pushed to one side)
a CT is also done for staging
