Exam 1: Cancers of the GI System Flashcards
Oral cancer generally involves the _______ or _______ ?
mouth or throat
Oral cancer is generally a ___________ cell cancer ?
“Squamous” cell cancer
What are the risk factors for Oral cancer ?
- Tobacco use
- ETOH
- Sunlight (lips, external area)
- Smoking a pipe
What are the Manifestation(s) of Oral cancer ?
The oral tissue can look white (Leukoplakia) from smoking
How is testing for Oral cancer done ?
Through Biopsy
What is the Tx for Oral cancer ?
- Surgery (lesions need to be removed)
What is main concern after after oral cancer surgery ?
Nutrition
- Want to make sure the patient is able to consume liquids (ex: boost) to get the necessary nutrients
What are Risks/complications of Oral Cancer ?
- watch for bleeding
- pain
- dysphagia
- difficulty swallowing
- etc,.
True or False: Esophageal cancer is often advanced at the time of diagnosis ?
True
Esophageal cancers tend to be what ?
Adenocarcinomas
- arise from the glandular tissue lining the esophagus
What are risk factors for Esophageal Cancer ?
- Barrett’s Esophagus
- ETOH consumption
- Smoking
- Occupational exposure to asbestos
What are Manifestations of Esophageal cancer ?
Early sign
- Difficulty swallowing (feels like a lump in the throat)
- Have a hard time eating things like meat, b/c its hard to get them down
Late sign
- Pain
How do they test for Esophageal cancer ?
Biopsy
Stomach Cancers tend to be what ?
Adenocarcinomas
What are the Risk factors for stomach cancer ?
- Asain population
- Smoking
- Obesity
- Exposure to irritants (ex: Tobacco)
- Reflux of bile into the stomach
- Anti-inflammatory drugs over time causing injury
- Smoked foods
- Salted fish & meat
- Pickled vegetables
Manifestations such as………. are seen with what type cancer ?
- Unexplained weight loss
- Early satiety (being full)
- Fatigue (d/t anemia that isn’t being picked up from a very small GI bleed)
- Hemorrhaging (which may not be noticeable in th stool)
Stomach Cancer
What type of Testing is used for Stomach cancer ?
EGD w/ biopsies
What is the Tx for Stomach Cancer ?
- Billroth I or II
OR
- A total Gastrectomy (depending on size & location of tumor)
- Combination chemotherapy/radiation
- Targeted therapy (If applicable)What are the Risks/complications of Stomach cancer ?
If a pt. had a total gastrectomy
- would be worried about a leak at the anastomosis site
After a gastrectomy
- worried about dumping syndrome
- worried about vitamins that have not been absorbed
True or False: If a pt. has an NG tube after a total gastrectomy , we DO NOT irrigate the NG tube ?
TRUE !
B/c were always concerned about the suture lline
True or False: With Stomach cancer, immediately post-op the pt’s will be having IV fluids ?
True
- Will need lots of fluids !
What is the Tx for Esophageal cancer ?
A combination of surgery and then depending on the stage of cancer, chemotherapy or radiation
What are Risks/complications of Esophageal cancer ?
- Airway !!!
- after surgery if we have resected something and there is inflammation, etc, we WANT TO MAKE SURE THE AIRWAY STAYS PATENT !!!
What are other complications of Esophageal cancer ?
- Communication: can be difficult
- Nutrition!!!
- B/c these pt’s are not going to be able to eat through their mouth for a while.
- They will have a temporary gastrotomy tube, so we can feed into the stomach until the esophagus heals
What is the second leading cause of death from cancer ?
Colorectal cancer
Colorectal cancer is more common in what sex ?
Males
Colorectal cancer is the leading cause of death seen in what race ?
African Americans
- possibly d/t poor diet, poor screenings, decreased access to health care, etc.
Colorectal cancer, is typically what type of cancer ?
Adenocarcinoma
What are Risk factors for Colorectal Cancer ?
- Family Hx (1st degree relative: mom, dad,sibling)
- IBD (ex: Crohn’s, UC, Polyps)
- Obesity (BMI > - 30)
- Red meat (>- 7 servings per week)
- Smoking
- ETOH (> 4 drinks per week)
- DM
True or False: Physical exercise, a diet high in fruits, vegetables, and grains decreases the risk for colon cancer ?
True :)
True or False: Colorectal cancer can very much be asymptomatic until the disease is advanced ?
True :(
True or False: We need to do A LOT of teaching w/ patients in regards to colorectal cancer ?
True
True or False: Screenings for colorectal cancer are very important !?
True
True to False: Not everybody with colon cancer ends up with an ostomy ?
True
Manifestations such as…. are seen with what type of cancer ?
- Insidious onset may be vague and nonspecific
- Abdominal discomfort
- Fatigue (may be d/t some loss of blood- visible or not)
- Rectal bleeding (if low enough in the colon)
- Sensations of incomplete evacuation
- Weight loss
- Change in stools (color, shape, consistency, pattern)
Colon cancer
What is the Management for colon cancer include ?
- Surgery* - only curative Tx
- depends on location & involvement, regarding type of surgery
- Prognosis coorelates with staging
- Procedures
- Right hemicolectomy (if thats the side its on)
- Left hemicolectomy (If thats the side its on)
- Abdominal-Perineal resection
What type of procedure for colon cancer involves, 1 incision in the abdominal area, and 1 incision in the perineal/rectal area ?
Abdominal - Perineal resection
- in this case an ostomy is formed
The symptoms below, correlate to colon cancer in which area of the Large intestine (colon) ?
- Pain
- Mass
- Change in bowel habits
- Anemia
Ascending colon
The symptoms below, correlate to colon cancer in which area of the Large intestine (colon) ?
- Pain
- Obstruction
- Change In bowel habits
- Anemia
Transverse colon
The symptoms below, correlate to colon cancer in which area of the Large intestine (colon) ?
- Pain
- Change in bowel habits
- bright red blood in stool
- Obstruction
Descending colon
The symptoms below, correlate to colon cancer in which area of the Large intestine (colon) ?
- Blood in stool
- Change in bowel habits
- Rectal discomfort
Rectum
True or False: Pt’s with cancer in either the ascending or transverse colon, may or may not have pain ?
True
Stools are more liquidly in what area of the Large intestine (aka: colon) ?
Ascending colon
Stools are more formed, in what part of the large intestine (aka: colon) ?
Descending colon
What are Diagnostics used for Colon cancer ?
- Rectal exam
- Testing stool for occult blood
- Sigmoidoscopy
- COLONOSCOPY - Gold Standard !
- CEA (Carcinoembryonic Antigen)
- DNA test
- CT scan
True or False: Sometimes with a digital rectal exam, with a gloved finger, polyps can be palpated ?
True
What type of diagnostic test for colon cancer involves, a scope that goes up through the rectum and visualizes the sigmoid colon ?
Sigmoidoscopy
What type of diagnostic test involves bowel prep and inserting a scope through the anal area, and the scope can go up and all the way around & look at the intentional tissue ?
Colonoscopy ! (Gold Standard)
True or False: the diagnostic test (blood test) CEA = a tumor marker ?
True
-CEA shouldn’t normally be secreted by us
an embryo would make this substance…??
An example of a DNA diagnostic test for colon cancer is what ?
Cologuard
True or False: If a pt. does a DNA diagnostic test (ex: Cologuard) and DNA changes are seen in the stool, that will most likely lead a physical to order a colonoscopy where they can actually look at the intestinal mucosa through their scope ?
True
True or False:
- Cologuard is intended for people who are not high risk for colon cancer
- More providers are starting to offer it because its much less expensive & doesn’t involve a bowel prep ?
True
For individuals at average risk for colon cancer, they should have one of the following procedures starting at age 50 for prevention and screening ?
- Sigmoidoscopy (every 5yrs)
- Colonoscopy (every 10yrs)
- Virtual colonoscopy (every 5yrs)*
- Double-contrast barium enema (every 5yrs)*
- if positive –> do colonoscopy
- If polyps removed, colonoscopy moved up to every 5yrs
If your at increased or high risk for colon cancer, prevention & screening usually start between what ages ?
40 to 50yrs
- Sometimes even earlier than that
If you are at increased or high risk for colon cancer, how often should you have a colonoscopy ?
Every 5yrs
If there is a family hx of colon cancer, what age should screening begin at ?
Begin at 40 or 10yrs before the age of the youngest family member diagnosis
Ex: if you had a parent you had colon cancer at age 45, then you would probably start screening at age 35
