Gastro cancer stuff

Question 1

Red flag signs for oesophageal cancer and gastric cancer?

Answer 1

• Palpable upper abdo mass consistent with gastric cancer (gastric cancer)
• New or changed dysphasia in any ag group
• Age >/= 55 with weight loss + upper abdominal pain/reflux/dyspepsia

Question 2

Risk factors for oesophageal cancer?

Answer 2

• Adenocarcinoma (lower 1/3): GORD, Barrret’s, smoking, achalisa, obesity
• Squamous cell carcinoma (upper 2/3): smoking, alcohol, achalasia, Plummer-Vinson, diets rich in nitrosamines (cooked meats, beer, cheeses)

Question 3

Risk factors for gastric cancer?

Answer 3

H.pylori (strongest), blood group A, gastric adenomatous polyps, pernicious anaemia, smoking, diet high in salts, spices & nitrates, male, som countries (Japan, China, Finland, Columbia)

Question 4

What 2 nodes are palpable in gastric cancer?

Answer 4

• Virchow’s (left supraclavicular)
• Sister Mary Joseph’s (paraumbilical)

Question 5

Diagnostic and staging investigations for oesophageal and gastric cancer?

Answer 5

• Diagnostic: endoscopy with biopsy
• Staging: CT TAP (1st line), endoscopic USS (2nd line)
• Can also do PET CT and contrast swallow to exclude motility disorder in oesophageal cancer

Question 6

2WW referral pathway for colorectal cancer?

Answer 6

• Positive faecal occult blood
• Rectal or abdominal mass
• Age >40 + unexplained weight loss and abdo pain
• Age >50 + unexplained rectal bleeding
• Age >60 + iron deficiency anaemia or change in bowel habit
• Age <50 +rectal bleeding + one of abdominal pain, change in bowel habit, eight loss or iron deficiency anaemia
• Unexplained iron deficiency anaemia
• Anal fissure not in midline

Question 7

Risk factors for colorectal cancer?

Answer 7

FMH, FAP, HNPCC, IBD, old age, diet high in red meat and low in fibre, obesity, smoking, alcohol, radiotherapy for prostate cancer

Question 8

Investigations forr colorectal cancer?

Answer 8

• Diagnostic: colonoscopy + biopsy; if only rectal bleeding can do sigmoidoscopy; if unfit for colonoscopy CT with bowel prep
• Staging/mets: CT TAP
• CEA tumour marker

Question 9

Screening for colorectal cancer?

Answer 9

FIT test every 2-3 years for those aged 60-74