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Gastroenterology > Gastrointestinal Cancer > Flashcards

Gastrointestinal Cancer Flashcards

1
Q

What is meant by primary cancer?

A

arising directly from the cells in an organ

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2
Q

What is meant by secondary cancer?

A

a metastatic cancer spread to another organ directly or by other means such as blood or lymph

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3
Q

Where does squamous cell carcinoma arise from?

A

from normal oesophageal squamous epithelium involving the acetaldehyde pathway

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4
Q

Where does adenocarcinoma arise from?

A

metaplastic columnar epithelium and is related to acid reflux

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5
Q

Outline the progression of reflux to cancer

A

inflammation from reflux to barretts metaplasia oesophagus to dysplasia to adenocarcinoma

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6
Q

How do we carry out Barretts oesophagus surveillance according to the BSG guidelines?

A

no dysplasia -> every 2/3 years have endoscopy
with low grade dysplasia -> carry out endoscopy every 6 months
high grade dysplasia -> intervene

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7
Q

What are the clinical signs of oesophageal cancer?

A

dysphagia and weight loss

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8
Q

How do diagnose gastrointestinal tract cancer?

A

endoscopy biopsy to determine adenocarcinoma vs squamous cell carcinoma etc

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9
Q

How do we stage gastrointestinal tract cancer?

A

CT scan
laparoscopy - for metastasises
oesophageal ultrasound
PET scan - to pick up other metastasises

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10
Q

How do we treat adenocarcinoma GI cancer?

A

neo adjuvant chemotherapy

radical surgery

palliative treatment - chemotherapy, radiotherapy, oesophageal stent

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11
Q

What are the forms of colorectal cancer?

A

sporadic - no family history

familial - family history of colorectal cancer

hereditary syndrome - family history, younger age of onset, specific gene defects

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12
Q

What are examples of colorectal cancer with a hereditary syndrome?

A

familial adenomatous polyposis

hereditary non polyposis colorectal cancer

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13
Q

Outline the pathogenesis of colorectal cancer

A

1 a normal epithelium with an APC mutation

2 leads to a hyperproliferative epithelium with an aberrant cryptic fold resulting in aberrant COX 2 overexpression which results in a small adenoma (polyp)

3 K-ras mutation can lead to the small adenoma forming a large adenoma

4 p53 mutation paired with loss of 18q results in colon carcinoma

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14
Q

How can aspirin, folate and calcium reduce risk of colorectal cancer

A
  • by affecting APC mutation that leads to hyperproliferative endothelium
  • aspirin can inhibit COX preventing a small adenoma
  • aspirin can inhibit K-ras mutation resulting in reduced risk of large adenoma
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15
Q

What are the risk factors for colorectal cancer?

A

family history - identified genetic predisposition such as FAP

past history - colorectal cancer, adenoma, ulcerative colitis, radiotherapy

diet/ environmental - ie carcinogenic foods, smoking, obesity, socioeconomic status

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16
Q

How does caecal cancer present clinically?

A

iron deficiency anaemia

change of bowel habit commonly diarrhoea

distal ileum obstruction

palpable mass

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17
Q

What is the difference between sigmoidscopy and colonoscopy

A

smaller endoscope only assessing sigmoid colon and rectal cancer

whereas colonscopy assess all of the colon

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18
Q

How does sigmoid carcinoma present?

A

PR bleeding and more mucus

very thin stool

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19
Q

What are symptoms of rectal carcinoma?

A

PR bleeding, mucus, anal perineal and sacral pain

tenesmus - feeling that you need to pass stool despite empty bowel

bowel obstruction

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20
Q

What are signs of local invasion?

A

bladder symptoms
female genital tract symptoms

distal rectal examination

metastasis - liver (jaundice, lung (cough) , regional lymph nodes, sister mary joseph nodule (umbilicus metastatic cancer that is visible)

21
Q

What are the signs of primary cancer?

A

abdominal mass
rigid sigmoidscopy
abdominal tenderness and distension

22
Q

How do we diagnose colorectal cancer?

A

FBC - showing anaemia and low ferritin
Tumour markers - CEA (but its not diagnostic alone)
guaiac test - to detect fecal occult blood
FIT - faecal immunochemical test which also detects faecal occult blood

23
Q

How do we investigate colorectal cancer?

A

colonoscopy under sedation - can visualise lesions less than 5mm

small polyps can be removed to reduce the cancer incidence

or CT colonoscopy/colonography

24
Q

What is CT colonoscopy/colonography?

A

less invasive and can visualise lesions greater than 5mm -> if lesions identified patient needs colonoscopy for diagnosis

25
Q

What other imaging tests can be done for colorectal cancer?

A

Mri pelvis

CT chest, abdo, pelvis to exclude metastasis

26
Q

How do we manage colorectal cancer?

A

right and transverse colon - resection and primary anastomosis

left side : hartmann’s procedure (colectomy and then giving a colostomy) which can be reversed

primary anastamosis - (intraoperative bowel lavage with primary anastomosis) resulting in a defunctioning ileostomy

palliative option - stent

27
Q

Outline a right hemicolectomy

A

right colon removed then ileocolic anastomosis is formed

28
Q

Outline an extended right hemicolectomy

A

right colon and portion of transverse colon is removed and ileocolic anastomosis is formed

29
Q

Outline left hemicolectomy

A

removal of left colon and anastomosis with anus - but an ileostomy is preferred

30
Q

What is the most common form of pancreatic cancer?

A

pancreatic ductal adenocarcinoma

31
Q

What are the risk factor for pancreatic cancer?

A 
chronic pancreatitis 
type 2 diabetes
gallstones, pernicious anaemia 
poor diet
occupation - exposure to acylamide, insecticides 
cigarette smoking
family history
32
Q

What are genes hereditary pancreatitis is associated with?

A

PRSS1 - cationic trypsinogen
SPINK1 - panc secretory trypsin inhibitor
CTFR

33
Q

Outline the pathogenesis of pancreatic cancer

A

1 pancreatic intraepithelial neoplasia aka PanIN

PDAs evolve through non invasive neoplastic precursor lesions

2 PanIN’s are microscopic and not visible in pancreatic imaging

3 the PanIN’s acquire clonally selected genetic and epigenetic alterations along the way

34
Q

How does pancreatic cancer present?

A 
jaundice - palpable gallbladder 
weight loss - diabetes 
pain - epigastrium and back
atypical attack of acute pancreatitis 
gastrointestinal bleeding
35
Q

What investigations can be done for pancreatic cancer?

A

Tumour marker CA19-9 - falsely elevated in pancreatitis

ultrasonography - to identify pancreatic tumours, dilated bile ducts, liver metastases

dual phase CT

MRI
mrcp

ERCP - very useful

36
Q

What can mrcp be used for in investigating pancreatic cancer?

A

provides ductal images without complications of ERCP

37
Q

What can ercp be used for in investigating pancreatic cancer?

A

confirms the typical double duct sign

aspiration/brushing of the bile duct system

therapeutic modality -> biliary stenting to relieve jaundice

38
Q

What can endoscopic ultrasound be used for in investigating pancreatic cancer?

A

highly sensitive in the detection of small tumour -> can assessing vascular invasion
and is useful for fine needle aspiration

39
Q

What can laparoscopy and laparoscopic ultrasound be used for investigating pancreatic cancer?

A

detecting radiologically occult metastatic lesions of lier and peritoneal cavity

40
Q

What can PET scan be used for investigating in pancreatic cancer?

A

PET mainly used for demonstrating occult metastases

41
Q

Outline a head of pancreas resection

A

Ripples resection

42
Q

Outline tail of pancreas resection

A

remove spleen and remove the splenic artery

43
Q

What are the types of liver cancer?

A

hepatocellular carcinoma
cholangiocarcinoma
gallbladder carcinoma
colorectal cancer metastases

44
Q

What is hepatocellular carcinoma often associated with?

A

70-90% have underlying cirrhosis

45
Q

What is the most common and effective treatment for hepatocellular carcinoma?

A

liver transplant

46
Q

What can cause gallbladder?

A

unknown but associated with gallstones, porcelain gall bladder and chronic typhoid infection

47
Q

What can cause cholangiocarcinoma?

A

ulcerative colitis and primary sclerosing cholangitis
choledochal cysts
liver fluke

48
Q

What are curative treatments for cholangiocarcinoma?

A

excising the treatment in surgery

Gastroenterology (6 decks)

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