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Gastro cancers Flashcards

1
Q

Where can neuroendocrine tumors occur?

A

Liver
Pancreas
Colon

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2
Q

Where can GI cancers occur?

A

Anywhere along the GI tract:
Oesophagus
Stomach
Liver
Pancreas
Colon

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3
Q

def Cancer

A

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

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4
Q

Primary cancer def

A

Arising directly from the cells in an organ

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5
Q

Secondary/Metastasis cancer def

A

Spread from another organ, directly or by other means (blood or lymph)

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6
Q

What are the 6 hallmarks of cancer?

A

Sustaining proliferative signaling
Evading growth suppressors
Resistant to cell death
Activating invasion and metastasis
Enabling replicative immortality
Inducing angiogenesis

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7
Q

What 4 factors underlie the 6 hallmarks of cancer?

A

Deregulation of cellular energetics
Avoiding immune destruction
Tumor-promoting inflammation
Genome instability+mutation

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8
Q

What is the key principle that makes fighting cancer difficult?

A

Easy to kill cancer, hard to kill just cancer

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9
Q

What GI cancer arises from squamous cells?

A

Squamous cell carcinoma

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10
Q

What GI cancer arises from glandular epithelium?

A

Adenocarcinoma

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11
Q

What GI cancer arises from enteroendocrine cells?

A

Neuroendocrine Tumours (NETs)

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12
Q

What GI cancer arises from interstitial cells of cajal?

A

Gastrointestinal Stromal Tumours (GISTs)

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13
Q

What GI cancer arises from smooth muscle?

A

Leiomyoma/leiomyosarcomas

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14
Q

What GI cancer arises from adipose tissue?

A

Liposarcomas

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15
Q

How many cases of GI cancer were there in 2017 and 2018?

A

367,167 - 2017
164,901 - 2018

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16
Q
A
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17
Q

What is the criteria to decide whether you should screen for a gastric disease(7)?

A

Wilson & Jungner criteria

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18
Q

Outline screening for colorectal cancer

A

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).

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19
Q

Outline screening for esophageal cancer

A

Regular endoscopy to patients with:
Barrett’s oesophagus
Low - high-grade dysplasia.

20
Q

Outline screening for gastric and pancreatic cancer

A

No test exists that meets the W & J criteria.
Depends on incidence - Japan screens for gastric cancer

21
Q

Outline screening for hepatocellular cancer

A

Regular ultrasound & AFP for high-risk individuals with cirrhosis
Viral hepatitis
Alcoholic hepatitis.

22
Q

Give 2 examples of conditions which require screening with strong family history

A

FAP – yearly OGDs & colonoscopies
Hereditary pancreatitis - PRSS1, SPINK1​, CFTR​ gene mutations - 40% lifetime risk of pancreatic cancer

23
Q

3 major steps in a patients’ cancer journey

24
Q

Outline the cancer MDT between initial presentation and treatment

25
Name people within the CMDT
Pathologist Radiologist Palliative care Gastroenterologist Oncologist Surgeon Cancer nurse specialist
26
How is the confirmation of a cancer diagnosis made?
Biopsy samples-**Done by pathologist**
27
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
28
What is the role of the radiologist in the CMDT?
Review scans Find tumor stage Provide re-staging after treatment Perform interventional radiology
29
What is the surgeons' role in the CMDT?
Decides whether surgery is appropriate Performs+cares for patients in the post-operative period
30
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
31
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)?
32
What are the 3 paths of treatment that a CMDT ultimately decides on?
Radical (curative) Palliative therapy Palliative care
33
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
33
Outline the pathenogenesis of oesophangitis
Inflammatory condition 30% of UK population -Caused by GORD
34
Outline the pathenogenesis of barretts oesophagus
Intestinal metaplasia Occurs in 5% of pts with GORD Metaplasia → mild → moderate → severe dysplasia’ → cancer
35
Outline the pathenogenesis of adenocarcinoma
Occurs in 0.5-11% patients with Barrett’s per year.
36
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)
36
Commonest symptom of oesophageal cancer?
Dysphagia
37
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
38
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**
39
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?
40
Describe the pathenogenesis of stomach cancer from chronic gastritis to malignancy
Chronic gastritis → Intestinal metaplasia → Dysplasia → Malignancy
41
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
42
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
43
What are the palliative approaches for gastric cancer?
Stenting or Gastro-jejunal anastomosis
44

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