Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 Gastrointestinal > Gastrointestinal cancers > Flashcards

Gastrointestinal cancers Flashcards

1
Q

What is the anatomy of the stomach?

A

.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is gastric cancer? Types?

A

Gastric malignancy, most commonly adenocarcinoma, more rarely lymphoma or leiomyosarcoma (smooth muscle tissue).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors of gastric cancer? (x9)

A

Helicobacter pylori infection, atrophic gastritis (chronic inflammation of gastric mucosa), diet high in smoked, processed foods and nitrosamines (e.g. meat preservatives), smoking, obesity, Epstein-Barr virus, alcohol, pernicious anaemia, blood group A.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the epidemiology of gastric cancer: Where? UK incidence? Gender? Age?

A

Highest incidence in Asia, especially in Japan and China, 6th most common cancer in the UK (23 in 100 000 annual incidence), 2:1 male:female, age over 50 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the trends in location of gastric cancer in stomach anatomy? Possible explanation?

A

Cancer of antrum and body is becoming less common, while that of the cardia and gastro-oesophageal junction is increasing. Possible explanation: we have been very good in recent decades at treating and preventing H. pylori which typically causes non-cardia gastric cancer. Meanwhile, some have suggested that H. pylori is protective against cardia-related gastric cancers as it reduces proximal acid production; therefore, fall in H. pylori has promoted a rise in cardia cancers. In addition, smoking has been implicated in the rise of cardia cancers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the symptoms of gastric cancer? (x9 – x3 sensation, x2 food, x3 blood, x1 swallowing)

A

o Initially asymptomatic and very non-specific

o Early satiety

o Epigastric discomfort

o Dyspepsia in patients over 55

o Weight loss and anorexia

o N&V

o Haematemesis

o Melaena (dark/black faeces)

o Symptoms of anaemia

o Dysphagia (when there are tumours of the cardia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are symptoms of metastatic gastric cancer? (x2)

A

Abdominal swelling (ascites) or jaundice (liver involvement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs of gastric cancer? (x7)

A

o Physical examination may be normal. Note that if you observe these signs, it is likely that the disease is incurable.

o Epigastric mass

o Hepatomegaly

o Abdominal tenderness

o Signs of anaemia

o Virchow’s node/Troisier’s sign: lymphadenopathy in left supraclavicular fossa

o Sister Mary Joseph node: metastatic nodule on umbilicus

o Krukenberg’s tumour: ovarian metastases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What investigations are there for gastric cancer? (x8)

A

o UPPER GI ENDOSCOPY: with multi-quadrant biopsy of all gastric ulcers

o BLOODS: FBC for anaemia, LFT to assess liver compromise

o CT/MRI: staging of tumour and planning of surgery

o ULTRASOUND OF LIVER: staging of tumour

o BONE SCAN: staging of tumour

o ENDOSCOPIC ULTRASOUND: assess depth of invasion and lymph node spread

o LAPAROSCOPY: may be needed to determine if tumour is resectable.

o CYTOLOGY of PERITONEAL WASHINGS can help identify peritoneal metastases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is colorectal carcinoma?

A

Malignant adenocarcinoma of the large bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the aetiology of colorectal carcinoma?

A

Environmental and genetic factors have been implicated. A sequence of epithelial dysplasia leading to adenoma then carcinoma is thought to occur, involving accumulation of genetic changes in oncogenes (APC, K-ras) and tumour suppressor genes (p53 and DCC).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the distribution of colorectal carcinoma in the colon?

A

60% in the rectum and sigmoid colon, 15-20% in the ascending colon, remainder in the transverse and descending colon.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the risk factors of colorectal carcinoma? (x6)

A

Diet, obesity, smoking, diet (low fibre, red and processed meats), IBD, inherited conditions (familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer (HNPCC)).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the epidemiology of colorectal carcinoma: Common? Deaths? Age? Gender?

A

Second most common cause of cancer death in the West. 20 000 deaths per year. Average age of diagnosis – 60-65 years. Equal gender distribution.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the ethnic and gender distribution of colorectal carcinoma anatomy?

A

Black women have more proximal neoplasms; white men have more distal neoplasms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the specific symptoms of colorectal carcinoma: left-sided colon and rectum? (x3)

A

o Change in bowel habit

o Rectal bleeding or blood/mucous mixed with stool

o Rectal masses present as tenesmus (sensation of incomplete emptying after defecation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the specific symptoms of colorectal carcinoma: right-sided colon? (x4)

A

Later presentation with symptoms of anaemia, weight loss, non-specific malaise, and rarely lower abdominal pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How may patients present with complications of colorectal carcinoma? (x3)

A

Pain and distension caused by large bowel obstruction, haemorrhage, or peritonitis as a result of perforation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the signs of colorectal carcinoma? (x3)

A

o Anaemia may be the only sign, particularly in right-sided lesions

o Abdominal mass

o Low-lying rectal tumours may be palpable on rectal examination

20
Q

What are the signs of metastatic colorectal disease? (x2)

A

HEPATOMEGALY, ‘shifting dullness’ of ASCITES.

21
Q

What are the investigations for colorectal carcinoma? (x8)

A

o BLOODS: FBC for anaemia, LFT for liver compromise, tumour markers (CEA (carcino embryonic antigen) to monitor treatment response or disease recurrence).

o STOOL: occult (not visibly apparent) or frank blood in stool (can be used as a screening test)

o ENDOSCOPY: sigmoidoscopy, colonoscopy. Allows visualisation and biopsy. Polypectomy can also be performed if isolated small carcinoma in situ.

o BARIUM CONTRAST STUDIES: look for ‘apple core’ stricture on barium enema.

o ABDOMINAL USS: for hepatic metastases

o CXR: for staging

o CT/MRI: for staging

o ENDORECTAL ULTRASOUND: for staging

22
Q

What does an apple core stricture look like on barium enema?

A

.

23
Q

What is the anatomy of the large intestine wall?

A

.

24
Q

What is Dukes’ staging for colorectal cancer?

A

Dukes’ stage A: limited to muscularis mucosae; B: breached muscularis mucosae, negative lymph nodes; C: breached serosa, positive lymph nodes; D: distant metastases.

25
Q

What is the TNM staging of colorectal cancer?

A

.

26
Q

What is a colonic polyp?

A

A protuberance into the lumen from the normally flat colonic mucosa.

27
Q

What are the two types of colonic polyp?

A

Neoplastic and non-neoplastic.

28
Q

What are neoplastic colonic polyps? (x2)

A

Include adenomas and adenocarcinomas.

29
Q

What are non-neoplastic polyps? (x3)

A

Include hyperplastic polyps, inflammatory pseudopolyps (islands of intact colonic mucosa resulting from mucosal ulceration and regeneration that occurs in IBD), and hamartomatous polyps (polyps which arise from a systemic genetic condition rather than from a single mutated cell)

30
Q

What is an example of a disease that gives rise to hamaromatous polyps?

A

Peutz-Jeghers syndrome – autosomal dominant disorder presenting with polyps and mucocutaneous pigmentation of lips and gums

31
Q

What conditions give rise to multiple colonic polyps? (x3)

A

Autosomal dominant conditions caused by mutations in the adenomatous polyposis coli (APC) gene. These give rise to: Familial adenomatous polyposis (FAP), and variants of FAP including Turcot’s syndrome (FAP associated with glioblastomas or medulloblastomas), and Gardner’s syndrome (FAP associated with osteomas, soft-tissue tumours and sebaceous cysts).

32
Q

What is the epidemiology of colonic polyps: Prevalence?

A

Over 50% of those over 60 years old.

33
Q

What is an oesophageal carcinoma?

A

Malignant tumour arising in the oesophageal mucosa.

34
Q

What are the two main histological types of oesophageal carcinoma?

A

Squamous cell carcinoma (arising from squamous cell epithelium of the oesophagus) and adenocarcinoma (arising from glandular cells).

35
Q

What is the cellular anatomy of the oesophageal lining?

A

Lined by squamous cell epithelium and mucus-secreting cells (adeno-).

36
Q

!!! What is the aetiology of squamous cell carcinoma? (x13)

A

o Alcohol

o Tobacco

o Hot tea

o Certain nutritional deficiencies (vitamins, trace elements)

o HPV infection

o ACHALASIA

o Paterson-Kelly (Plummer-Vinson) syndrome (disease characterised by dysphagia, glossitis and iron-deficiency anaemia)

o Tylosis (Howel-Evans syndrome) (genetic condition of hyperkeratosis, associated with high lifetime risk of oesophageal cancer)

o Scleroderma (autoimmune connective tissue disorder)

o Coeliac disease

o Lye stricture

o History of previous thoracic radiotherapy or upper aerodigestive squamous cancer

o Dietary nitrosamines

37
Q

!!! What is the aetiology of adenocarcinoma? (x2)

A

GORD and Barrett’s oesophagus (intestinal metaplasia of the distal oesophageal mucosa from squamous cell to columnar)

38
Q

What is the anatomical stie of each type of oesophageal carcinoma?

A

Squamous cell is more common in the mid-upper oesophagus; adenocarcinoma more common in lower oesophagus or, increasingly, the gastro-oesophageal junction.

39
Q

What is the typical spread of oesophageal carcinoma?

A

Spread is initially direct, and longitudinal via an extensive network of submucosal lymphatics to tracheobronchial, mediastinal, coeliac, gastric and cervical nodes.

40
Q

What are other rare types of oesophageal tumour?

A

Lymphoma, melanoma, leiomyosarcoma.

41
Q

What is the epidemiology of oesophageal carcinoma: Incidence? Gender? Epidemiology of each type? Geography? Age? Trend?

A

Eight most common malignancy in the UK, 3-4:1 male:female, most common type WORLDWIDE is squamous cell carcinoma (95%), adenocarcinoma is more common in WESTERN countries (65% of cases in the UK), high incidence in northern China, Iran and Southern Russia, 60-70 years old. Adenocarcinoma is rising.

42
Q

What are the symptoms of oesophageal carcinoma? (x1 and x9)

A

o EARLY: reflux

o LATER: dysphagia, initially worse for solids. Regurgitation, vomiting blood, cough or choking after food, pain (odynophagia), retrosternal pain, weight loss, fatigue, voice hoarseness (may indicate recurrent laryngeal nerve palsy)

43
Q

What does paroxysmal mean?

A

Sudden occurrence or exacerbation.

44
Q

When may cough in oesophageal carcinoma be paroxysmal?

A

In aspiration pneumonia from a tumour found proximally.

45
Q

What oesophageal symptoms are more relevant to proximal tumours? (x2)

A

Cough/choking after food intake and hoarseness.

46
Q

What are the signs of oesophageal carcinoma? (x2 and x2)

A

No physical signs may be evident other than weight loss and respiratory signs related to aspiration or direct tracheobronchial (metastatic) involvement. With metastatic disease, there may be supraclavicular lymphadenopathy, hepatomegaly.

47
Q

What are the investigations for oesophageal carcinoma? (x7)

A

o ENDOSCOPY (oesophagoscopy): tumour location and biopsy. Gold standard.

o BARIUM SWALLOW: detects occlusive tumour

o ENDOSCOPIC ULTRASOUND (EUS): for staging.

o CT: for staging.

o PET: can detect previously occult (no symptoms) distant metastases.

o BRONCHOSCOPY: if there is a risk of tracheobronchial invasion

o LAPAROSCOPY: if there is significant infra-diaphragmatic component

Year 3 Gastrointestinal (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions