Gastro cancers Flashcards
Where can neuroendocrine tumors occur?
Liver
Pancreas
Colon
Where can GI cancers occur?
Anywhere along the GI tract:
Oesophagus
Stomach
Liver
Pancreas
Colon
def Cancer
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems
Primary cancer def
Arising directly from the cells in an organ
Secondary/Metastasis cancer def
Spread from another organ, directly or by other means (blood or lymph)
What are the 6 hallmarks of cancer?
Sustaining proliferative signaling
Evading growth suppressors
Resistant to cell death
Activating invasion and metastasis
Enabling replicative immortality
Inducing angiogenesis
What 4 factors underlie the 6 hallmarks of cancer?
Deregulation of cellular energetics
Avoiding immune destruction
Tumor-promoting inflammation
Genome instability+mutation
What is the key principle that makes fighting cancer difficult?
Easy to kill cancer, hard to kill just cancer
What GI cancer arises from squamous cells?
Squamous cell carcinoma
What GI cancer arises from glandular epithelium?
Adenocarcinoma
What GI cancer arises from enteroendocrine cells?
Neuroendocrine Tumours (NETs)
What GI cancer arises from interstitial cells of cajal?
Gastrointestinal Stromal Tumours (GISTs)
What GI cancer arises from smooth muscle?
Leiomyoma/leiomyosarcomas
What GI cancer arises from adipose tissue?
Liposarcomas
How many cases of GI cancer were there in 2017 and 2018?
367,167 - 2017
164,901 - 2018
What is the criteria to decide whether you should screen for a gastric disease(7)?
Wilson & Jungner criteria
Outline screening for colorectal cancer
Offered to healthy individuals:
Faecal immunochemical test (FIT) - detects haemoglobin in faeces, every 2 years for everyone aged 60-74
One-off sigmoidoscopy for everyone aged >55 to remove polyps (reducing future risk of cancer).
Outline screening for esophageal cancer
Regular endoscopy to patients with:
Barrett’s oesophagus
Low - high-grade dysplasia.
Outline screening for gastric and pancreatic cancer
No test exists that meets the W & J criteria.
Depends on incidence - Japan screens for gastric cancer
Outline screening for hepatocellular cancer
Regular ultrasound & AFP for high-risk individuals with cirrhosis
Viral hepatitis
Alcoholic hepatitis.
Give 2 examples of conditions which require screening with strong family history
FAP – yearly OGDs & colonoscopies
Hereditary pancreatitis - PRSS1, SPINK1, CFTR gene mutations - 40% lifetime risk of pancreatic cancer
3 major steps in a patients’ cancer journey
Outline the cancer MDT between initial presentation and treatment
Name people within the CMDT
Pathologist
Radiologist
Palliative care
Gastroenterologist
Oncologist
Surgeon
Cancer nurse specialist
How is the confirmation of a cancer diagnosis made?
Biopsy samples-Done by pathologist
What 3 things can a cancer biopsy tell us?
Histologic typing-Definition of what type of cell the cancer derived from
Molecular typing-Identifying the mutation causing the cancer
Tumor grade-Identifying how aggressive the tumor is
What is the role of the radiologist in the CMDT?
Review scans
Find tumor stage
Provide re-staging after treatment
Perform interventional radiology
What is the surgeons’ role in the CMDT?
Decides whether surgery is appropriate
Performs+cares for patients in the post-operative period
What is the role of the gastroenterologist in the CMDT?
Endoscopy – diagnostic & therapeutic
Upper GI
Oesophageal & gastric biopsies
Oesophageal stents
Liver & pancreas
ERCP & EUS biopsies
Biliary stents
Lower GI
Colonic biopsies
Colonic stents
What is the role of the oncologist in the CMDT?
Decides on whether chemotherapy, radiotherapy or other systemic therapy is appropriate.
Coordinates the overall treatment plan
Should chemotherapy come before surgery (neoadjuvant) or after (adjuvant)?
What are the 3 paths of treatment that a CMDT ultimately decides on?
Radical (curative)
Palliative therapy
Palliative care
Describe the different pathenogenesis of squamous cell carcinoma and adenocarcinoma
Squamous Cell Carcinoma
Upper 2/3
Develops from normal oesophageal squamous epithelium
Commonest in developing world
Adenocarcinoma
Lower 1/3 of oesophagus
Squamous epithelium that has become columnar (metaplastic)
Related to acid reflux
Commonest in developed world
Outline the pathenogenesis of oesophangitis
Inflammatory condition
30% of UK population
-Caused by GORD
Outline the pathenogenesis of barretts oesophagus
Intestinal metaplasia
Occurs in 5% of pts with GORD
Metaplasia → mild → moderate → severe dysplasia’ → cancer
Outline the pathenogenesis of adenocarcinoma
Occurs in 0.5-11% patients with Barrett’s per year.
Why is oesophageal cancer presentation usually late?
Significant cancer growth needs to occur before dysphagia develops.
Often have metastases
Most patients deemed unfit for surgery at diagnosis (malnourished)
Commonest symptom of oesophageal cancer?
Dysphagia
Outline oesophageal cancer diagnosis and staging
Upper GI endoscopy (Oesophagogastroduodenoscopy, OGD)
If lesion is found → biopsy taken to confirm the diagnosis.
Investigations used to stage the cancer:
CT of chest & abdomen
PET-CT scan to exclude metastases
Staging laparoscopy
To identify liver & peritoneal metastases
Endoscopic ultrasound
Via oesophagus to clarify depth of invasion & involvement of local lymph nodes
Give the risks factors for stomach cancer
Chronic gastritis is the major driver
H.pylori infection
due to chronic acid overproduction
Pernicious anaemia
autoantibodies against parts & products of parietal cells
Partial gastrectomy (e.g. for an ulcer)
leading to bile reflux
Epstein-Barr virus infection
Family history (including heritable diffuse-type gastric cancer due to E-cadherin mutations)
High salt diet & smoking
2 major treatment pathways of oesophageal cancer and what 2 questions must be fulfilled for the more radical pathway?
Is tumor surgically resectable with no distant metastases?
and
Is patient fit enough for major surgery?
Describe the pathenogenesis of stomach cancer from chronic gastritis to malignancy
Chronic gastritis → Intestinal metaplasia → Dysplasia → Malignancy
What is the commonest symptom of gastric cancer and what are the red flags(ALARMS55)?
Commonest symptom = Dyspepsia
Anaemia
Loss of weight or appetite
Abdominal mass on examination
Recent onset of progressive symptoms
Melaena or haematemesis
Swallowing difficulty
55 years of age or above
Outline the diagnosis and staging of gastric cancer
Diagnosis - similar to oesophageal cancer: endoscopy + biopsy
Staging
CT of the chest, abdomen & pelvis will provide information on distant lesions
PET-CT
Diagnostic laparoscopy - peritoneal & liver metastases disease prior to full operation
Endoscopic ultrasound - will give most detail about local invasion & node involvement
What are the palliative approaches for gastric cancer?
Stenting or Gastro-jejunal anastomosis
