Gastro Cancers Flashcards
What are the layers of the bowel moving from lumen outwards ?
Mucosa
Submucosa
Muscularis propria
subserosa
Serosa
What is the muscularis propria comprised of ?
A thick layer of muscle that lies deep to the submucosa.
Inner ring of circular fibres and outer ring of longitudinal bundles
What are some risk factors of colorectal cancer ?
Age
Family history
Genetic syndromes ( familial adenomatous polyposis & hereditary nonpolyposis colorectal cancer )
Previous history of colorectal cancer or polyps
IBD
Poor diet
Obesity
what is familial adenomatous polyposis ?
An inherited autosomal dominant pattern that is caused by a mutation in the APC gene. This is a tumour suppressor gene which causes a loss of function mutation resulting in the decreased ability to prevent the development of tumours.
What is hereditary nonpolyposis colorectal cancer ?
Inherited autosomal dominant pattern and is caused by a mutation in a DNA mismatch repair gene.
What are some protective factors of colorectal cancer ?
NSAIDs
Statins
COCP
What are some screening modalities for colorectal cancer ?
Faecal immunotherapy testing ( FIT )
Colonoscopy
Flexible sigmoidoscopy
What is the most common type of colorectal cancer ?
Adenocarcinoma
How does colorectal adenocarcinoma arise ?
From gland cells that line the wall of the colon or rectum and produce mucus
What are some signs, symptoms and complications of colorectal cancer ?
Bowel habit changes
Tenesmus
Blood in stool
Fatigue
Nausea or vomiting
Loss of appetite
Weight loss
Bowel obstruction or perforation
What are some signs and symptoms that suggest colorectal cancer has spread ?
Hepatomegaly
Jaundice
Ascites
SOB
What lab investigations should be performed for colorectal cancer ?
FBC
FIT
LFT
CEA levels
U&Es
What imaging should be performed for colorectal cancer ?
Colonoscopy
AXR and CXR
CT chest abdo pelvis
USS liver if suspicion of spread
Other than imaging and lab tests what else should be performed when suspecting colorectal cancer ?
Biopsy
What are some management options for colorectal cancer ?
Surgery ( local excision, bowel resection, colostomy )
Palliative surgery
Chemotherapy
Radiation therapy
Targeted therapy
What are some side effects associated with bowel resection ?
Pain
Bleeding
Thrombosis
Paralytic ileus
Adhesions
Anastomotic leak
Infection
What are some side effects from chemotherapy for colorectal cancer ?
Bone marrow suppression
Diarrheoa
Skin changes
Sore mouth
Nausea and vomiting
Loss of appetite
What are some side effects of radiotherapy fro colorectal cancer ?
Diarrheoa
Incontinence
Bowel obstruction
Urinary frequency
What are some pathohistological factors associated with colorectal cancer that result in a worse prognosis ?
Positive surgical margins
Lymphovascular invasion
Higher pathological grade
Signet ring cell adenocarcinoma
Small cell carcinoma
Genetic mutations
what are the 2 most common types of oesophageal cancer ?
Squamous cell carcinoma
Adenocarcinoma
What are some differences between adenocarcinoma and squamous cell carcinoma in the oesophagus ?
Squamous - extensive local growth
Adenocarcinoma - less locally invasive but spreads more rapidly to lymph nodes ( lower 1/3 is affected )
What are some risk factors for oesophageal cancer ?
Male
Higher age
Radiation exposure therapy
Obesity
Barrett’s oesophagus
Smoking
What is Barrett’s oesophagus ?
Repetitive regurgitation of gastric contents irritates the oesophagus squamous mucosa causing inflammation. This can cause the squamous cells to transform into glandular epithelium which is called Barrett’s oesophagus.
How does oesophageal cancer present ?
Dysphagia
Weight loss
Rare - odynophagia, recurrent vomiting, hoarseness of voice
Why does hoarseness of the voice occur in oesophageal cancer ?
If the recurrent laryngeal nerve is involved
Upon physical examination what can be detected in oesophageal cancer ?
Palpable mass
Lymphadenopathy
Organomegaly
Cardio resp abnormalities in advanced disease
What lab investigations should be performed when suspecting oesophageal cancer ?
FBC
U&E’s
LFTs
Tumour markers - CEA and CA19-9
What are some investigations ( exclusion lab tests ) for oesophageal cancer ?
Endoscopic USS
Biopsy
Bronchoscopy
CT chest abdo
What is the management of oesophageal cancer ?
Endoscopic therapy
Surgery
Chemotherapy and radiotherapy
Metastatic disease - targeted therapy ( palliative )
What are some morbidities from treatment for oesophageal cancer ?
Surgical complications
Radiation toxicity
What are some toxicities from using radiotherapy as a treatment for oesophageal cancer ?
Oesophagitis
Dysphagia
Nausea and vomiting
Dehydration
Fatigue
Dermatitis
Changes in gastric motility and emptying
What is the gastric cardia ?
Region of the stomach near the gastroesophageal sphincter junction
What is the fundus of the stomach ?
Part of the stomach located superior to the level of the gastroesophageal sphincter junction
What is the pylorus of the stomach ?
Most distal portion of the stomach
What is the pyloric sphincter ?
It regulates the passage of chyme from the pylorus to the duodenum.
What is the lesser curvature of the stomach ?
Forms the medial border of the stomach and attaches to the liver by the lesser omentum.
What is the greater curvature of the stomach ?
Attached to the diaphragm, spleen, transverse colon by the greater omentum.
What is the vascular supply of the stomach derived from ?
Branches of the celiac artery which arises from the aorta at the level of T12/L1.
What is the most common type of stomach cancer ?
Adenocarcinoma
What are some modifiable risk factors for gastric cancer ?
H.Pylori and EBV
Smoking
Alcohol consumption
Obesity
Radiation exposure
What are some non-modifiable risk factors for gastric cancer ?
Race / ethnicity
Male
Age
Family history
Genetic conditions
What are the most common symptoms and signs of gastric cancer ?
Abdo pain
Weight loss
Dysphagia
Persistent vomiting
Early satiety
What investigations should be performed when suspecting gastric cancer ?
FBC
U&Es
LFT’s
CEA and ca19-9 tumour markers
Endoscopy
PET/CT
Ct chest abdo pelvis
What are some management options for gastric cancer ?
Surgery
Radiotherapy
Systemic therapy
If gastric cancer is metastatic what management options are there ?
Chemo radiation for localised disease
Systemic therapy
What is the oral cavity ?
A collection of sub sites of the upper aero digestive tract that play a key role in mastication, articulation, swallowing and breathing.
What are some modifiable factors for oral cavity cancer ?
Alcohol consumption
Tobacco smoking
Sun exposure
Poor oral hygiene
Chronic oral inflammation
What are some non-modifiable factors for oral cavity cancer ?
Male
Age
Past cancer history
Family history
Past radiation exposure
What is leukoplakia ?
White well defined keratotic patches
What is erythroplakia ?
Red mucosal plaques with ill defined borders
What are some premalignant oral lesions ?
Leukoplakia
Erythroplakia
Lichen planus
How does oral cavity cancer present ?
Leukoplakia
Erythroplakia
Dysphagia
Odynophagia
Halitosis
What is the management of oral cavity cancer ?
Surgery
Radiation
Chemotherapy
Targeted therapy
Immunotherapy
What are some modifiable risk factors of pancreatic cancer ?
Chronic pancreatitis - excessive alcohol consumption
Smoking
Diabetes
Obesity
What are some non-modifiable risk factors of pancreatic cancer ?
Genetic predisposition
Familial pancreatic cancer
CF
Pancreatic cysts
Who gets screened for pancreatic cancer ?
First degree relative with familial pancreatic cancer
Patients who have peutz-jeghers syndrome
Family with lynch syndrome
Patients with hereditary pancreatitis
How does pancreatic cancer spread ?
Local
lymphatic
Haematogenous
How does pancreatic cancer present ?
Asymptomatic at first
Jaundice
Abdominal pain
Weight loss
What are some laboratory tests to perform when suspecting pancreatic cancer ?
FBC, u&Es
LFT’s
Serum lipase
Tumour marker CA19-9
What are some imaging options for pancreatic cancer ?
USS - first line
CT - used to confirm positive US findings
MRI
ERCP - visualise the biliary tree and pancreatic ducts
What are some differentials for a pancreatic mass ?
Cyst
Cancer
Pancreatitis
What is the most common type of pancreatic cancer ?
Ductal adenocarcinoma
Where does the cancer arise from if it is an exocrine pancreatic neoplasm ?
Ductal and acinar cells
Where does the cancer arise from if it is an endocrine pancreatic neoplasm ?
Islet cells
What is the curative treatment for pancreatic cancer ?
Surgery
What surgery is performed if there is a head of the pancreas cancer ?
Whipple procedure
When is chemo/radiotherapy given in pancreatic cancer ?
Neoadjuvant
Adjuvant
Palliative
What surgery is performed for caecal cancer ?
Right hemicolectomy
What surgery is used for a transverse colon cancer ?
Extended right hemicolectomy
What surgery is performed for left colon cancer ?
Left hemicolectomy
What surgery is performed for sigmoid colon cancer ?
sigmoidcolectomy
What surgery is performed for rectal cancer ?
Anterior resection of the rectum
What alternative surgery can be performed if the rectal cancer is low ?
Abdominal-perineal excision of rectum
What histological staging is used for colorectal cancer and what are the stages ?
1 - within the bowel wall
2 - through the bowel wall
3 - lymph nodes involved
4 - distant mets
Which bowel cancer site is radiotherapy appropriate for ?
Rectal cancer
Not colon
What are the palliative surgical options for bowel cancer ?
Stents
Bypass
Defunctioning stoma
Palliative resection
