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BRS Year 2 > gastrointestinal cancers > Flashcards

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

Features and epidemiology of oesophageal SCC?

A

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

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12
Q

Features epidemiology of oesophageal adenocarcinoma?

A

arises from metaplastic columnar epithelium
lower 1/3 of oesophagus
related to acid reflux
more developed world
Affects the elderly (highest M reported cases at 70-74, highest F reported cases at 85+)
Affects more males than females (10:1)

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13
Q

how does reflxux cause 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 <20%)
Palliation is difficult

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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
possible laparoscopy
rarer - endoscopic ultrasound, PET scans

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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 Esophagectomy)

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20
Q

what is a Two stage Ivor lewis oesohagectomy?

A

the esophageal tumor is removed through an abdominal incision and a right thoracotomy (2 cuts so 2 stage)
Then esophagogastric anastomosis

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21
Q

palliative treatment for oesophageal cancer?

A

chemo
DXT (radiotherapy)
stents

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22
Q

what are the forms of colorectal cancer

A

usually all adenocarcinomas. Can be:
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
Q

what is hereditary syndrome colorectal cancer?

A

FH, younger age of onset, specific gene defects (FAP, HNPCC/Lynch syndrome)
FAP - familial adenomatous polyposis HNPCC - hereditry nonpolyposis colorectal cancer

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26
Q

what is the epidemiology of colorectal cancer?

A 
most common GI cancer western
3rd highest death rates of cancer
1in 10 men
1 in 14 women
generally over 50s
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27
Q

what are the risk factors for colorectal cancer?

A

PMH: colorectal cancer, adenoma, UC, radiotherapy
FH: 1st degree relatives, genetic predispositions
Diet/Environment: carcinogenic food, smoking, obesity, socioeconomic status

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28
Q

what is the disease process for colorectal cancer?

A
  1. normal epithelium (APC mutation) - can be caused by NSAIDs/aspirin, folate, calcium
  2. hyperproliferative epithelium, aberrant cryptic foci (COX-2 overexpression)- aspirin/NSAIDs
  3. small adenoma (K-ras mutation)- oestrogen, aspirin/NSAIDs
  4. large adenoma (p53 mutation, loss of 18q)
  5. colon carcinoma +invasion
29
Q

what is the most common location for colorectal cancer presentation?

A

2/3 desc colon, rectum

1/2 sigmoid colon, rectum (within reach of flexible sigmoidoscopy)

30
Q

how does caecal and right sided colorectal cancer present?

A 
iron deficiency anaemia
bowel habit change - diarrhoea
distal iluem obstruction (late)
palpable mass (late)
31
Q

how does left sided and sigmoid colorectal cancer present?

A

PR bleeding
mucus in stool
thin stool (late)

32
Q

how does rectal colorectal cancer present?(rectal carcinoma)

A 
PR bleeding
mucus 
tenesmus - want to open bowels but nothing released
anal, perineal and sacral pain (late)
bowel obstruction (late)
33
Q

what are the symptoms of local colorectal cancer invasions?

A

bladder symptoms

female genital tract symptoms

34
Q

what are the locations and symptoms of metastasis of colorectal cancer?

A

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
Q

what are the signs on examination of a primary colorectal cancer?

A

abdominal mass, tenderness and distention (large bowel obstruction)
digital rectum exam - most under 12cm dentate
rigid sigmoidoscopy

36
Q

what are the investigations for colorectal cancer?

A 
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
Q

what are the faecal occult blood tests for colorectal cancer?

A

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
Q

what can blood tests show for colorectal cancer?

A

anaemia
haematinics - low ferritin
tumour marker CEA for monitoring - not diagnostic

39
Q

how can colonoscopy aid colorectal cancer diagnosis?

A

visualise lesions smaller than 5mm

removal of small polyps - reduced cancer incidence

40
Q

how can CT colonoscopies aid colorectal cancer diagnosis?

A

visualise lesions larger than 5mm
less invasive and better tolerated
but if lesions identified, patient needs colonoscopy for diagnosis

41
Q

how do MRI pelvis help with rectal carcinoma?

A

depth of invasion and mesorectal lymph involvement shown
no bowel prep necessary
helps choose between preoperative chemoradiotherapy vs straight to surgery

42
Q

how is colorectal cancer typically managed?

A

by surgery

maybe by stents/radiotherapy/chemotherapy

43
Q

how is an obstructing colorectal cancer in the right and transverse colon managed?

A 
resection and primary anastamosis - good blood supply, low risk of leaking
right hemicolectomy (asc) or extended right hemicolectomy (transverse and asc)
44
Q

how is an obstructing colorectal cancer in the left side managed?

A

Hartmann’s procedure - formation of colostomy (colon goes straight to skin, rectum sealed off) reversible
or Primary anastamosis - 10% leakage
Palliative stent

45
Q

why is management of right sided colorectal cancer easier than left sided?

A

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
Q

what is the most common form of pancreatic cancer?

A

pancreatic ductal adenocarcinoma

47
Q

risk factors for pancreatic cancer

A 
chronic pancreatitis
T2DM
smoking
family history
occupation - insecticides, nickel etc
48
Q

pathogenesis of pancreatic cancer

A

non-invasive neoplastic precursor lesions
acquire genetic and epigenetic alterations along the way to become cancer
from PanIN-1A - PanIN-3

49
Q

clinical presentation of pancreatic cancer - head

A

most common
jaundice - painless, palpable gallbladder
weight loss - anorexia, malabsorption and diabetes
pain - epigastrium - back

50
Q

signs of advanced head of pancreas cancer

A

persistent vomiting due to duodenal obstruction

gastrointestinal bleeds - duodenal invasion or varices secondary to portal or splenic vein occlusion

51
Q

clinical presentation of pancreatic cancer - tail and body

A 
insidious
marked weight loss
back pain
jaundice uncommon
vomiting very late stage - DJ flexure
52
Q

investigaitons for pancreatic cancer

A 
tumour marker CA19-9 
ultrasonography
dual phase CT
MRI
MRCP
ERCP
EUS
Laparoscopy
PET
53
Q

importance of tumour marker CA19-9 in pancreatic cancer

A

greater sensitivity at higher concentrations

falsely elevated in pancreatitis, hepatic dysfunction, obstructive jaundice

54
Q

ultrasonography findings for pancreatic cancer

A

dilated bile ducts
liver metastases
can identify tumours

55
Q

use of dual phase CT in pancreatic cancer

A

confers resectability in most cases
shows vascular and other organ invasion
distant mets

56
Q

MRCP and ERCP in pancreatic cancer

A

MRCP - ductal images wihtout ERCP complications

ERCP - confirms double duct sign, aspiraition of bile-duct system, also therapeutic (biliary stenting - jaundice)

57
Q

resections of pancreatic cancer

A

HOP - whipples resection (distal bile duct and gallbladder, distal stomach and duodenum too)
TOP - distal pancreas removed, take out splenic artery and spleen

58
Q

what is hepatocellular cancer

A

cancer of hepatic cells

primary liver cancer

59
Q

where is cholangiocarcinoma most likely to be

A

bifurcation of common hepatic duct (right/left)

60
Q

what is cholangiocarcinoma

A

cancer of bile ducts

61
Q

what cancer commonly metastasises to the liver

A

colorectal cancer

62
Q

what is hepatocellular cancer associated with

A

underlying cirrhosis

63
Q

treatment of hepatocellular cancer

A

liver transplant
trans arterial catheter embolisation
radiofrequency ablation
last 4-6mnth without it, 5yr with

64
Q

gallbladder cancer associated with

A

gallstones
porcelain gallstones
chronic typhoid infection

65
Q

treatment for gallbladder cancer

A

removal

66
Q

cholgangiocarcinoma associated with

A

ulcerative colitis and primary sclerosing cholangitis
liver fluke
choledochal cysts

67
Q

treatment for cholangiocarcinoma

A

excision

68
Q

secondary liver cancer treatment

A

excision

survival 50% possible

BRS Year 2 (110 decks)

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