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Block 32 GI & Surgery > CT 2.4 Intra-abdominal Cancer > Flashcards

CT 2.4 Intra-abdominal Cancer Flashcards

1
Q

which form of intra-abdominal cancer is the most common

A

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

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2
Q

what blood test marker is used for CRC

A

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
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3
Q

what tumour marker is used for pancreatic cancer

A

CA19.9 carbohydrate antigen

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4
Q

which tumour marker is used for hepatocellular carcinoma

A

AFP alpha fetoprotein

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5
Q

what is adjuvant treatment

A

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.

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6
Q

what are the most common cancers in the UK

A

breast
lung
prostate
CRC
melanoma

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7
Q

what are the mortality trends for different types of cancers

A

1 Lung cancer
2 CRC
3 prostate
4 breast
5 pancreatic

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8
Q

what is the distribution of colorectal cancers

A

2/3rd of colorectal cancers are found distal to the splenic flexure

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9
Q

how do bowel cancers spread

A

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

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10
Q

what is the relationship between polyps and colorectal cancer

A

the larger the polyp the more likely it is to be cancerous

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11
Q

How are cancers staged

A

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

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12
Q

what are some ways to treat rectal cancer

A

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

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13
Q

what adjuvant treatment is shown to reduce the recurrence of rectal cancer alongside surgery

A

radiotherapy with surgery confers better outcomes in the years post surgery

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14
Q

what is the histological pattern of gastric cancer

A

90% are adenocarcinomas

squamous cell

GI stromal tumour - is a type of sarcoma found in wall of stomach

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15
Q

what are the risk factors for gastric cancer

A

h.pylori infection

smoked foods

tobacco and alcohol

pernicious anaemia and achlorhidria

blood group A

male

age - 50 to 70

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16
Q

presentation of gastric cancer

A

often late presentation

upper abdominal pain

weight loss
anaemia
anorexia - not wanting to eat
early satiety
N+V

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17
Q

what are the two types of oesophageal cancer

A

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]

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18
Q

what are the investigations for gastric cancer

A

FBC - anaemia, plasma proteins and malnutrition

endoscopy biopsy, CT chest and abdomen

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19
Q

what is plummer vinson syndrome

A

a triad of

dysphagia
glossitis
iron deficiency anaemia

20
Q

what are the symptoms of oesophageal cancer

A

dysphagia
odynophagia
anorexia or weight loss
N+V
hoarseness
cough
haematemesis
melena

21
Q

what is the gold standard for investigation and diagnosis

A

OGD and biopsy

22
Q

what is a complication of surgery

A

anastomotic leak - if leakage occurs into thoracic cavity may lead to mediastinitis

23
Q

In gastric cancer what nodes may be palpated in lymphatic spread

A

left supraclavicular virchows node

sister mary josephs nodes in the periumbilical area

24
Q

to confirm a diagnosis of gastric cancer a OGD and biopsy is done. what cells may be present

A

signet ring cells (large clear area due to enlarged vacuole with nucleus pushed to one side)

a CT is also done for staging

25
Q

what is the management of gastric cancer

A

endoscopic mucosal resection

partial or total gastrectomy

26
Q

what are the complications of total gastrectomy

A

dumping syndrome
B12 deficiency
osteoporosis
increased gastric cancer risk?

27
Q

which cancers is bombesin a tumour marker for

A

small cell carcinoma of the lung,
gastric cancer
pancreatic cancer
neuroblastoma

28
Q

what are the three types of CRC

A

1) sporadic colorectal cancer 95%

2) HNPCC or lynch syndrome 5%

3) familial adenomatous polyposis <1%

29
Q

what anatomical locations are most colorectal cancers found

A

rectum, sigmoid colon, ascending colon/caecum, transverse
colon, and descending colon.

30
Q

what histology are most Colorectal cancer tumours

A

adenocarcinomas 90%

other minorities include squamous cell and neuroendocrine

31
Q

sporadic CRC is thought to be caused by acquired mutations through the lifetime of an individual. what mutations are involved in the onset of CRC

A

APC tumour suppressor gene
KRAS oncogene
p53 tumour suppressor gene
DCC tumour suppressor

32
Q

what is HNPCC/lynch syndrome

A

autosomal dominant condition, with MSH2 and MLH1 genes being
associated (genes involved in DNA mismatch repair). The cancer often affects the proximal colon,
and is usually very aggressive. People with HNPCC are also at a higher risk of developing
endometrial, gastric, pancreatic and ovarian cancer, in that order, and there may be family history of
these cancers too

33
Q

what is FAP

A

FAP is an autosomal dominant condition which leads to the formation of hundreds to thousands of
benign polyps/adenomas in the colon by the age of 30-40 years, which inevitably develop into
carcinoma. It is due to a mutation in the APC tumour suppressor gene on chromosome 5. FAP
patients are also at risk of duodenal tumours

34
Q

what are the risk factors for CRC

A

age
IBD
diet and lifestyle
smoking and alcohol

35
Q

what are signs of right sided colon cancer

A

abdominal pain
fatigue
unintentional weight loss
iron deficiency anaemia
change in bowel habit
RIF mass
darker blood in stool

36
Q

what are signs of a left sided colon cancer

A

rectal bleeding
change in bowel habit
brighter blood in stools
abdominal pain
tenesmus
causes symptoms earlier than right sided

37
Q

what investigations are done for CRC

A

colonoscopy
flexible sigmoidoscopy (mostly those with only PR bleeding)
CT colonography for those unfit for colonoscopy

38
Q

dukes criteria

A

dukes A - tumour confined to mucosa

B - invasion of bowel wall

C - lymph node mets

D - distant mets

39
Q

what is a right hemicolectomy

A

removal of caecum, ascending colon, and proximal transverse colon

40
Q

what is a left hemicolectomy

A

removal of distal transverse colon, and descending colon

41
Q

what is a high anterior resection

A

removal of sigmoid colon (may be called a sigmoid colectomy)

42
Q

what is a low anterior resection

A

removal of sigmoid colon and upper rectum, but sparing the lower
rectum and anus

43
Q

what is abdomino-perineal resection

A

removal of rectum and anus (with or without the sigmoid colon), and suturing over the anus. It leaves the patient with permanent end colostomy

44
Q

what is hartmann’s procedure

A

emergency procedure where the sigmoid colon is resected (and the rectal stump is sutured closed), and an end colostomy is created (which may be permanent or
reversed at a later date).

Common indications for this are acute obstruction by a tumour, or
significant diverticular disease
perforation or obstruction

45
Q
A

Block 32 GI & Surgery (8 decks)

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