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gastrointestinal cancers Flashcards

1
Q

what is cancer?

A

a disease caused by uncontrolled division of abnormal cells ina part of the body

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2
Q

what is primary cancer

A

arising directly from the cells in an organ

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3
Q

what is a secondary cancer?

A

spread to another organ, directly or by other means

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4
Q

cancer of glandular epithelium

A

adenocarcinoma - most common

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5
Q

most common cancer of GI tract type? not location

A

adenocarcinoma

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6
Q

cancer of squamous epithelium?

A

SCC squamous cell carcinoma

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7
Q

cancer of enteroendocrine cells

A

neuroendocrine tumours (NETs)

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8
Q

cancer of interstitial cells of Cajal

A

gastrointestinal stromal tumours (GISTs)

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9
Q

cancer of smooth muscle

A

leiomyoma

leiomyosarcoma

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10
Q

cancer of adipose tissue

A

liposarcomas

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11
Q

epidemiology of oesophageal squamous cell carcinoma?

A

upper 2/3 of oesophagus
acetaldehyde pathway (alcohol related)
less developed world

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12
Q

epidemiology of oesophageal adenocarcinoma?

A 
arises from metaplastic columnar epithelium
lower 1/3 of oesophagus
related to acid reflux
more developed world
elderly
male 10.1 female
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13
Q

how does reflux lead to cancer?

A

oesophagitis (GORD)
Barretts (metaplasia)
dysplasia (low-high grade)
adenocarcinoma (neoplasia)

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14
Q

what are the surveillance rules for Barretts oesophagus?

A

no dysplasia - 2/3 years
low grade dysplasia - 6monthly
high grade dysplasia - interventions

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15
Q

how do oesophageal cancers often present?

A

LATE with dysphagia and weight loss
therefore 65% palliative
poor 5 year survival

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16
Q

how are survival rates for oesophageal adenocarcinoma?

A

65% palliative cases
high morbidity, high risk surgeries
less than 20% 5 year survival

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17
Q

what is the diagnosis process for oesophageal cancer?

A

2wk cancer referral service

endoscopy and biopsy

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18
Q

how is staging for oesophageal cancer determined?

A

primarily CT scan CAP

possible laparoscopy or PET scan (usually done as upper GI malignancy more aggressive than lower)

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19
Q

what is the curative treatment plan for oesophageal cancer?

A

neo-adjuvant chemotherapy then radical surgery (two stage Ivor Lewis Oesophagectomy)

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20
Q

what is a Two stage Ivor lewis oesohagectomy?

A

removal of oesophagus and stitch it to stomach

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21
Q

palliative treatment for oesophageal cancer?

A

chemo
DXT (anti-cancer agent)
stents

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22
Q

what are the forms of colorectal cancer

A

usually all adenocarcinomas
sporadic
familial
hereditary syndrome

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23
Q

what is sporadic colorectal cancer?

A

absence of FH, older population, isolated lesion

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24
Q

what is familial colorectal cancer?

A

FH, high risk if index case is under 50 and 1st degree relatives

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25
what is hereditary syndrome colorectal cancer?
FH, younger age of onset, specific gene defects (FAP, HNPCC/Lynch syndrome) FAP - familial adenomatous polyposis HNPCC - hereditry nonpolyposis colorectal cancer
26
what is the epidemiology of colorectal cancer?
``` most common GI cancer western 3rd highest death rates of cancer 1in 10 men 1 in 14 women generally over 50s ```
27
what are the risk factors for colorectal cancer?
PMH colorectal cancer, adenoma, UC, radiotherapy FH 1st degree relatives, genetic predispositions environment carcinogenic food, smoking, obesity, socioeconomic status
28
what is the disease process for colorectal cancer?
``` normal epi (APC mutation) hyperproliferative epi, abberant cryptic foci (COX-2 overexpression) small adenoma (K-ras mutation) large adenoma (p53 mutation, loss of 18q) colon carcinoma +invasion ```
29
what is the most common location for colorectal cancer presentation?
2/3 desc colon, rectum | 1/2 sigmoid colon, rectum
30
how does caecal and right sided colorectal cancer present?
``` iron deficiency anaemia bowel habit change - diarrhoea distal iluem obstruction (late) palpable mass (late) ```
31
how does left sided and sigmoid colorectal cancer present?
PR bleeding mucus in stool thin stool (late)
32
how does rectal colorectal cancer present?(rectal carcinoma)
``` PR bleeding mucus tenesmus - want to open bowels but nothing released anal, perineal and sacral pain (late) bowel obstruction (late) ```
33
what are the symptoms of local colorectal cancer invasions?
bladder symptoms | female genital tract symptoms
34
what are the locations and symptoms of metastasis of colorectal cancer?
liver - hepatic pain, jaundice (very far along) lung - cough, monophonic wheeze regional lymph nodes - swelling perioneum - sister mary joseph nodule (at umbilicus) bone pain
35
what are the examinations for a primary colorectal cancer?
abdominal mass, tenderness and distention (large bowel obstruction) digital rectum exam - most under 12cm dentate rigid sigmoidoscopy
36
what are the investigations for colorectal cancer?
``` faecal occult blood - Guaiac test (haemoccult), faecal immunochemical test FBC colonoscopy CT colonoscopy MRI pelvis for rectal cancer CT chest/abdo/pelvis (for staging) ```
37
what are the faecal occult blood tests for colorectal cancer?
Gaiac test - based on pseudoperoxidase activity of haematin sensitivity 40-80%, specificity 98% dietary restrictions of red meat, melon, horseradis, vit C and NSAIDs 3 days before faecal immunochemical test - detects minute amounts of blood in faeces
38
what can blood tests show for colorectal cancer?
anaemia - low ferritin | tumour marker CEA for monitoring - not diagnostic
39
how can colonoscopy aid colorectal cancer diagnosis?
visualise lesions smaller than 5mm | removal of small polyps - reduced cancer incidence
40
how can CT colonoscopies aid colorectal cancer diagnosis?
visualise lesions larger than 5mm less invasive and better tolerated but if lesions identified, patient needs colonoscopy for diagnosis
41
how do MRI pelvis help with rectal carcinoma?
depth of invasion and mesorectal lymph involvement shown no bowel prep necessary helps choose between preoperative chemoradiotherapy vs straight to surgery
42
how is colorectal cancer typically managed?
by surgery | maybe by stents/radiotherapy/chemotherapy
43
how is an obstructing colorectal cancer in the right and transverse colon managed?
``` resection and primary anastamosis - good blood supply, low risk of leaking right hemicolectomy (asc) or extended right hemicolectomy (transverse and asc) ```
44
how is an obstructing colorectal cancer in the left side managed?
Hartmann's procedure - formation of colostomy (colon goes straight to skin, rectum sealed off) reversible or Primary anastamosis - 10% leakage Palliative stent
45
why is management of right sided colorectal cancer easier than left sided?
right side blood supply - right colic artery, middle colic artery, ileocolic artery left side blood supply - left colic resection dependent on blood supply which is weaker on LHS rectum also very weak supply
46
what is the most common form of pancreatic cancer? (not location)
pancreatic ductal adenocarcinoma
47
risk factors for pancreatic cancer
``` chronic pancreatitis T2DM smoking family history occupation - insecticides, nickel etc ```
48
pathogenesis of pancreatic cancer
non-invasive neoplastic precursor lesions acquire genetic and epigenetic alterations along the way to become cancer from PanIN-1A - PanIN-3
49
clinical presentation of pancreatic cancer - head
most common location jaundice - painless, palpable gallbladder weight loss - anorexia, malabsorption and diabetes pain - epigastrium - back
50
signs of advanced head of pancreas cancer
persistent vomiting due to duodenal obstruction | gastrointestinal bleeds - duodenal invasion or varices secondary to portal or splenic vein occlusion
51
clinical presentation of pancreatic cancer - tail and body
``` insidious marked weight loss back pain jaundice uncommon vomiting very late stage - DJ flexure ```
52
investigations for pancreatic cancer
``` tumour marker CA19-9 ultrasonography dual phase CT MRI MRCP ERCP EUS Laparoscopy PET ```
53
importance of tumour marker CA19-9 in pancreatic cancer
greater sensitivity at higher concentrations | falsely elevated in pancreatitis, hepatic dysfunction, obstructive jaundice
54
ultrasonography findings for pancreatic cancer
dilated bile ducts liver metastases can identify tumours
55
use of dual phase CT in pancreatic cancer
confers resectability in most cases shows vascular and other organ invasion distant mets
56
MRCP and ERCP in pancreatic cancer
MRCP - ductal images wihtout ERCP complications | ERCP - confirms double duct sign, aspiraition of bile-duct system, also therapeutic (biliary stenting - jaundice)
57
resections of pancreatic cancer
HOP - whipples resection (distal bile duct and gallbladder, distal stomach and duodenum too) TOP - distal pancreas removed, take out splenic artery and spleen
58
what is hepatocellular cancer
cancer of hepatic cells | primary liver cancer
59
where is cholangiocarcinoma most likely to be
bifurcation of common hepatic duct (right/left)
60
what is cholangiocarcinoma
cancer of bile ducts
61
what cancer commonly metastasises to the liver
colorectal cancer
62
what is hepatocellular cancer associated with
underlying cirrhosis
63
treatment of hepatocellular cancer
liver transplant trans arterial catheter embolisation radiofrequency ablation last 4-6mnth without it, 5yr with
64
gallbladder cancer associated with
gallstones porcelain gallstones chronic typhoid infection
65
treatment for gallbladder cancer
removal
66
cholangiocarcinoma associated with
ulcerative colitis and primary sclerosing cholangitis liver fluke choledochal cysts
67
treatment for cholangiocarcinoma
excision
68
secondary liver cancer treatment
excision | survival 50% possible
69
history signs of difference between upper and lower oesophageal issues
painful on swallowing - upper | food easy to swallow but feels stuck seconds later - lower
70
staging investigation for confirmed colorectal cancer
CT chest abdo pelvis if in doubt about liver, MRI liver if rectal cancer, MRI of rectum PET or laparoscopy not required

BRS Year 2 (67 decks)

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