Gastrointestinal Cancers Flashcards
What are GI tract squamous cell cancers called?
Squamous cell carcinoma (SCC)
What are GI tract glandular epithelium cell cancers called?
Adenocarcinoma
What are GI tract enteroendocrine cell cancers called?
Neuroendocrine tumours (NETs)
What are GI tract interstitial cells of Cajal cancers called?
Gastrointestinal stromal tumours (GISTs)
What are GI tract smooth muscle cell cancers called?
Leiomyoma/leiomyosarcoma
What are GI tract adipose tissue cell cancers called?
Liposarcoma
What kind of cancer occurs in the top 2/3 of the oesophagus?
Squamous cell carcinoma
What kind of cancer commonly affects the bottom 1/3 of the oesophagus?
Adenocarcinomas
Describe the progression of the oesophagus from reflux to cancer.
-Oesophagitis -> Barrets (Metaplasia) ->Adenocarcinoma (neoplasia)
What is metaplasia?
Transformation of one cell type to another.
How do we diagnose oesophageal cancer?
Endoscopy then biopsy if we see anything weird.
If were suspicious of a lesion and have done OGD (oesophago-gastro-duodenoscopy) and know its submucosal what do we do?
Endoscopic ultrasound scan.
What is a laparoscopy?
Light tube with camera inserted into the abdomen with a small camera on the tip
What kind of cancer is colerectal (histopathology)
Adenocarcinoma
What does aspirin do for colorectal cancer?
Prevents the development of it.
How do caecal and right sided colorectal cancer patients present? (4)
- Iron deficiency anaemia (most common)
- Change of bowel habit (diarrhoea)
- Distal ileum obstruction (late sign)
- Palpable mass (late sign)
How do left sided and sigmoid carcinoma colorectal cancer patients present?
- PR (rectal) bleeding, mucus
- Thin stool (late sign)
How do rectal carcinoma colorectal cancer patients present? (3)
- PR bleeding, mucus
- Tenesmus- the feeling of needing to open bowels but nothing comes out when you try
- Anal, perineal, sacral pain (late sign)
What kind of a sign is bowel obstruction in colorectal cancer?
Late sign
What are these signs of?
- Abdominal mass
- Abdominal tenderness and distension- large bowel obstruction
- DRE: most <12cm from dentate line and reached by examining finger
- Rigid sigmoidoscopy
Primary cancer
What are these signs of:
- Hepatomegaly
- Monophonic wheeze
- Bone pain
Metastases
What investigations are there for colorectal cancer?
-Faecal occult blood
-Blood tests
-Colonoscopy
-CT colonoscopy/ colonography
-MRI pelvis
-CT chest/abdo/pelvis
Why is CT colonoscopy/colonography better than a normal colonoscopy?
There’s no need for sedation, less invasive.
What do we use to visualize lesions > 5mm?
CT colonoscopy/ colonography
What investigation do you do to measure the depth of invasion?
MRI the pelvis
Do right colon carcinomas usually obstruct and why?
No because there’s more leeway for growth.
What do we do with an obstructing right sided carcinoma in the right colon?
Resect then join up straight away as the blood supply is good.
Why do we have to be more careful with a left sided obstruction?
The blood supply is not as good on the left side
Why do we have to be more careful with a left sided obstruction?
The blood supply is not as good on the left side
What do we do instead where instead of joining proximal bowel and rectum, we bring proximal bowel up to skin and do a colostomy (leaving a stoma)- called a proximal end colostomy (LIF)
Hartmann’s procedure
Whats the difference between a stoma on the left or right side of a patient?
- left side means colostomy (large bowel)
- right side means ileostomy (small bowel)
What is the joining of two or more tubular structures within the body called?
Anastomose
What are the important right sided arteries?
- Ileocolic
- Right colic
- Middle colic
What are the important left sided arteries?
- Left colic
- When we get to pelvis, sigmoid arteries are important
What is a right hemicolectomy?
Remove right colon then anastomose terminal ileum to transverse colon
What is an extended right hemicolectomy?
Take around 2/3 of large bowel out- right colon and part of transverse
Then do ileocolic anastomosis
- What is a left hemicolectomy?
Resect left colon then anastomose remaining colon parts
What is it called when we bring up loop of small bowel to skin to divert faeces going through delicate anastomosis.
Ileostomy
What is the most common form of pancreatic cancer?
Pancreatic ductal adenocarcinoma (PDA)
What causes the biggest increase risk in pancreatic cancer?
Chronic pancreatitis, 18 x increase in risk.
What is the commonest pathogenesis of pancreatic ductal adenocarcinomas/ pancreatic cancer?
Pancreatic Intraepithelial Neoplasias (PanIN)
How does carcinoma of the head of the pancreas present? (6)
-Jaundice, due to compression of the CBD (common bile duct)
-Weight loss (due to malabsorbtion from exocrine insufficiency)
