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Y4 Cancer > Gastro Cancers > Flashcards

Gastro Cancers Flashcards

1
Q

What are the layers of the bowel moving from lumen outwards ?

A

Mucosa
Submucosa
Muscularis propria
subserosa
Serosa

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2
Q

What is the muscularis propria comprised of ?

A

A thick layer of muscle that lies deep to the submucosa.
Inner ring of circular fibres and outer ring of longitudinal bundles

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3
Q

What are some risk factors of colorectal cancer ?

A

Age
Family history
Genetic syndromes ( familial adenomatous polyposis & hereditary nonpolyposis colorectal cancer )
Previous history of colorectal cancer or polyps
IBD
Poor diet
Obesity

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4
Q

what is familial adenomatous polyposis ?

A

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.

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5
Q

What is hereditary nonpolyposis colorectal cancer ?

A

Inherited autosomal dominant pattern and is caused by a mutation in a DNA mismatch repair gene.

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6
Q

What are some protective factors of colorectal cancer ?

A

NSAIDs
Statins
COCP

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7
Q

What are some screening modalities for colorectal cancer ?

A

Faecal immunotherapy testing ( FIT )
Colonoscopy
Flexible sigmoidoscopy

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8
Q

What is the most common type of colorectal cancer ?

A

Adenocarcinoma

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9
Q

How does colorectal adenocarcinoma arise ?

A

From gland cells that line the wall of the colon or rectum and produce mucus

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10
Q

What are some signs, symptoms and complications of colorectal cancer ?

A

Bowel habit changes
Tenesmus
Blood in stool
Fatigue
Nausea or vomiting
Loss of appetite
Weight loss
Bowel obstruction or perforation

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11
Q

What are some signs and symptoms that suggest colorectal cancer has spread ?

A

Hepatomegaly
Jaundice
Ascites
SOB

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12
Q

What lab investigations should be performed for colorectal cancer ?

A

FBC
FIT
LFT
CEA levels
U&Es

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13
Q

What imaging should be performed for colorectal cancer ?

A

Colonoscopy
AXR and CXR
CT chest abdo pelvis
USS liver if suspicion of spread

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14
Q

Other than imaging and lab tests what else should be performed when suspecting colorectal cancer ?

A

Biopsy

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15
Q

What are some management options for colorectal cancer ?

A

Surgery ( local excision, bowel resection, colostomy )
Palliative surgery
Chemotherapy
Radiation therapy
Targeted therapy

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16
Q

What are some side effects associated with bowel resection ?

A

Pain
Bleeding
Thrombosis
Paralytic ileus
Adhesions
Anastomotic leak
Infection

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17
Q

What are some side effects from chemotherapy for colorectal cancer ?

A

Bone marrow suppression
Diarrheoa
Skin changes
Sore mouth
Nausea and vomiting
Loss of appetite

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18
Q

What are some side effects of radiotherapy fro colorectal cancer ?

A

Diarrheoa
Incontinence
Bowel obstruction
Urinary frequency

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19
Q

What are some pathohistological factors associated with colorectal cancer that result in a worse prognosis ?

A

Positive surgical margins
Lymphovascular invasion
Higher pathological grade
Signet ring cell adenocarcinoma
Small cell carcinoma
Genetic mutations

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20
Q

what are the 2 most common types of oesophageal cancer ?

A

Squamous cell carcinoma
Adenocarcinoma

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21
Q

What are some differences between adenocarcinoma and squamous cell carcinoma in the oesophagus ?

A

Squamous - extensive local growth
Adenocarcinoma - less locally invasive but spreads more rapidly to lymph nodes ( lower 1/3 is affected )

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22
Q

What are some risk factors for oesophageal cancer ?

A

Male
Higher age
Radiation exposure therapy
Obesity
Barrett’s oesophagus
Smoking

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23
Q

What is Barrett’s oesophagus ?

A

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.

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24
Q

How does oesophageal cancer present ?

A

Dysphagia
Weight loss

Rare - odynophagia, recurrent vomiting, hoarseness of voice

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25
Q

Why does hoarseness of the voice occur in oesophageal cancer ?

A

If the recurrent laryngeal nerve is involved

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26
Q

Upon physical examination what can be detected in oesophageal cancer ?

A

Palpable mass
Lymphadenopathy
Organomegaly
Cardio resp abnormalities in advanced disease

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27
Q

What lab investigations should be performed when suspecting oesophageal cancer ?

A

FBC
U&E’s
LFTs
Tumour markers - CEA and CA19-9

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28
Q

What are some investigations ( exclusion lab tests ) for oesophageal cancer ?

A

Endoscopic USS
Biopsy
Bronchoscopy
CT chest abdo

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29
Q

What is the management of oesophageal cancer ?

A

Endoscopic therapy
Surgery
Chemotherapy and radiotherapy
Metastatic disease - targeted therapy ( palliative )

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30
Q

What are some morbidities from treatment for oesophageal cancer ?

A

Surgical complications
Radiation toxicity

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31
Q

What are some toxicities from using radiotherapy as a treatment for oesophageal cancer ?

A

Oesophagitis
Dysphagia
Nausea and vomiting
Dehydration
Fatigue
Dermatitis
Changes in gastric motility and emptying

32
Q

What is the gastric cardia ?

A

Region of the stomach near the gastroesophageal sphincter junction

33
Q

What is the fundus of the stomach ?

A

Part of the stomach located superior to the level of the gastroesophageal sphincter junction

34
Q

What is the pylorus of the stomach ?

A

Most distal portion of the stomach

35
Q

What is the pyloric sphincter ?

A

It regulates the passage of chyme from the pylorus to the duodenum.

36
Q

What is the lesser curvature of the stomach ?

A

Forms the medial border of the stomach and attaches to the liver by the lesser omentum.

37
Q

What is the greater curvature of the stomach ?

A

Attached to the diaphragm, spleen, transverse colon by the greater omentum.

38
Q

What is the vascular supply of the stomach derived from ?

A

Branches of the celiac artery which arises from the aorta at the level of T12/L1.

39
Q

What is the most common type of stomach cancer ?

A

Adenocarcinoma

40
Q

What are some modifiable risk factors for gastric cancer ?

A

H.Pylori and EBV
Smoking
Alcohol consumption
Obesity
Radiation exposure

41
Q

What are some non-modifiable risk factors for gastric cancer ?

A

Race / ethnicity
Male
Age
Family history
Genetic conditions

42
Q

What are the most common symptoms and signs of gastric cancer ?

A

Abdo pain
Weight loss
Dysphagia
Persistent vomiting
Early satiety

43
Q

What investigations should be performed when suspecting gastric cancer ?

A

FBC
U&Es
LFT’s
CEA and ca19-9 tumour markers
Endoscopy
PET/CT
Ct chest abdo pelvis

44
Q

What are some management options for gastric cancer ?

A

Surgery
Radiotherapy
Systemic therapy

45
Q

If gastric cancer is metastatic what management options are there ?

A

Chemo radiation for localised disease
Systemic therapy

46
Q

What is the oral cavity ?

A

A collection of sub sites of the upper aero digestive tract that play a key role in mastication, articulation, swallowing and breathing.

47
Q

What are some modifiable factors for oral cavity cancer ?

A

Alcohol consumption
Tobacco smoking
Sun exposure
Poor oral hygiene
Chronic oral inflammation

48
Q

What are some non-modifiable factors for oral cavity cancer ?

A

Male
Age
Past cancer history
Family history
Past radiation exposure

49
Q

What is leukoplakia ?

A

White well defined keratotic patches

50
Q

What is erythroplakia ?

A

Red mucosal plaques with ill defined borders

51
Q

What are some premalignant oral lesions ?

A

Leukoplakia
Erythroplakia
Lichen planus

52
Q

How does oral cavity cancer present ?

A

Leukoplakia
Erythroplakia
Dysphagia
Odynophagia
Halitosis

53
Q

What is the management of oral cavity cancer ?

A

Surgery
Radiation
Chemotherapy
Targeted therapy
Immunotherapy

54
Q

What are some modifiable risk factors of pancreatic cancer ?

A

Chronic pancreatitis - excessive alcohol consumption
Smoking
Diabetes
Obesity

55
Q

What are some non-modifiable risk factors of pancreatic cancer ?

A

Genetic predisposition
Familial pancreatic cancer
CF
Pancreatic cysts

56
Q

Who gets screened for pancreatic cancer ?

A

First degree relative with familial pancreatic cancer
Patients who have peutz-jeghers syndrome
Family with lynch syndrome
Patients with hereditary pancreatitis

57
Q

How does pancreatic cancer spread ?

A

Local
lymphatic
Haematogenous

58
Q

How does pancreatic cancer present ?

A

Asymptomatic at first
Jaundice
Abdominal pain
Weight loss

59
Q

What are some laboratory tests to perform when suspecting pancreatic cancer ?

A

FBC, u&Es
LFT’s
Serum lipase
Tumour marker CA19-9

60
Q

What are some imaging options for pancreatic cancer ?

A

USS - first line
CT - used to confirm positive US findings
MRI
ERCP - visualise the biliary tree and pancreatic ducts

61
Q

What are some differentials for a pancreatic mass ?

A

Cyst
Cancer
Pancreatitis

62
Q

What is the most common type of pancreatic cancer ?

A

Ductal adenocarcinoma

63
Q

Where does the cancer arise from if it is an exocrine pancreatic neoplasm ?

A

Ductal and acinar cells

64
Q

Where does the cancer arise from if it is an endocrine pancreatic neoplasm ?

A

Islet cells

65
Q

What is the curative treatment for pancreatic cancer ?

A

Surgery

66
Q

What surgery is performed if there is a head of the pancreas cancer ?

A

Whipple procedure

67
Q

When is chemo/radiotherapy given in pancreatic cancer ?

A

Neoadjuvant
Adjuvant
Palliative

68
Q

What surgery is performed for caecal cancer ?

A

Right hemicolectomy

69
Q

What surgery is used for a transverse colon cancer ?

A

Extended right hemicolectomy

70
Q

What surgery is performed for left colon cancer ?

A

Left hemicolectomy

71
Q

What surgery is performed for sigmoid colon cancer ?

A

sigmoidcolectomy

72
Q

What surgery is performed for rectal cancer ?

A

Anterior resection of the rectum

73
Q

What alternative surgery can be performed if the rectal cancer is low ?

A

Abdominal-perineal excision of rectum

74
Q

What histological staging is used for colorectal cancer and what are the stages ?

A

1 - within the bowel wall
2 - through the bowel wall
3 - lymph nodes involved
4 - distant mets

75
Q

Which bowel cancer site is radiotherapy appropriate for ?

A

Rectal cancer
Not colon

76
Q

What are the palliative surgical options for bowel cancer ?

A

Stents
Bypass
Defunctioning stoma
Palliative resection

Y4 Cancer (12 decks)

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