Gastrointestinal Cancers

Question 1

What are GI tract squamous cell cancers called?

Answer 1

Squamous cell carcinoma (SCC)

Question 2

What are GI tract glandular epithelium cell cancers called?

Answer 2

Adenocarcinoma

Question 3

What are GI tract enteroendocrine cell cancers called?

Answer 3

Neuroendocrine tumours (NETs)

Question 4

What are GI tract interstitial cells of Cajal cancers called?

Answer 4

Gastrointestinal stromal tumours (GISTs)

Question 5

What are GI tract smooth muscle cell cancers called?

Answer 5

Leiomyoma/leiomyosarcoma

Question 6

What are GI tract adipose tissue cell cancers called?

Answer 6

Liposarcoma

Question 7

What kind of cancer occurs in the top 2/3 of the oesophagus?

Answer 7

Squamous cell carcinoma

Question 8

What kind of cancer commonly affects the bottom 1/3 of the oesophagus?

Answer 8

Adenocarcinomas

Question 9

Describe the progression of the oesophagus from reflux to cancer.

Answer 9

-Oesophagitis -> Barrets (Metaplasia) ->Adenocarcinoma (neoplasia)

Question 10

What is metaplasia?

Answer 10

Transformation of one cell type to another.

Question 11

How do we diagnose oesophageal cancer?

Answer 11

Endoscopy then biopsy if we see anything weird.

Question 12

If were suspicious of a lesion and have done OGD (oesophago-gastro-duodenoscopy) and know its submucosal what do we do?

Answer 12

Endoscopic ultrasound scan.

Question 13

What is a laparoscopy?

Answer 13

Light tube with camera inserted into the abdomen with a small camera on the tip

Question 14

What kind of cancer is colerectal (histopathology)

Answer 14

Adenocarcinoma

Question 15

What does aspirin do for colorectal cancer?

Answer 15

Prevents the development of it.

Question 16

How do caecal and right sided colorectal cancer patients present? (4)

Answer 16

• Iron deficiency anaemia (most common)
• Change of bowel habit (diarrhoea)
• Distal ileum obstruction (late sign)
• Palpable mass (late sign)

Question 17

How do left sided and sigmoid carcinoma colorectal cancer patients present?

Answer 17

• PR (rectal) bleeding, mucus
• Thin stool (late sign)

Question 18

How do rectal carcinoma colorectal cancer patients present? (3)

Answer 18

• PR bleeding, mucus
• Tenesmus- the feeling of needing to open bowels but nothing comes out when you try
• Anal, perineal, sacral pain (late sign)

Question 19

What kind of a sign is bowel obstruction in colorectal cancer?

Answer 19

Late sign

Question 20

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

Answer 20

Primary cancer

Question 21

What are these signs of:
- Hepatomegaly
- Monophonic wheeze
- Bone pain

Answer 21

Metastases

Question 22

What investigations are there for colorectal cancer?

Answer 22

-Faecal occult blood
-Blood tests
-Colonoscopy
-CT colonoscopy/ colonography
-MRI pelvis
-CT chest/abdo/pelvis

Question 23

Why is CT colonoscopy/colonography better than a normal colonoscopy?

Answer 23

There’s no need for sedation, less invasive.

Question 24

What do we use to visualize lesions > 5mm?

Answer 24

CT colonoscopy/ colonography

Question 25

What investigation do you do to measure the depth of invasion?

Answer 25

MRI the pelvis

Question 26

Do right colon carcinomas usually obstruct and why?

Answer 26

No because there’s more leeway for growth.

Question 27

What do we do with an obstructing right sided carcinoma in the right colon?

Answer 27

Resect then join up straight away as the blood supply is good.

Question 28

Why do we have to be more careful with a left sided obstruction?

Answer 28

The blood supply is not as good on the left side

Question 29

Why do we have to be more careful with a left sided obstruction?

Answer 29

The blood supply is not as good on the left side

Question 30

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)

Answer 30

Hartmann’s procedure

Question 31

Whats the difference between a stoma on the left or right side of a patient?

Answer 31

• left side means colostomy (large bowel)
• right side means ileostomy (small bowel)

Question 32

What is the joining of two or more tubular structures within the body called?

Answer 32

Anastomose

Question 33

What are the important right sided arteries?

Answer 33

• Ileocolic
• Right colic
• Middle colic

Question 34

What are the important left sided arteries?

Answer 34

• Left colic
• When we get to pelvis, sigmoid arteries are important

Question 35

What is a right hemicolectomy?

Answer 35

Remove right colon then anastomose terminal ileum to transverse colon

Question 36

What is an extended right hemicolectomy?

Answer 36

Take around 2/3 of large bowel out- right colon and part of transverse

Then do ileocolic anastomosis

Question 37

• What is a left hemicolectomy?

Answer 37

Resect left colon then anastomose remaining colon parts

Question 38

What is it called when we bring up loop of small bowel to skin to divert faeces going through delicate anastomosis.

Answer 38

Ileostomy

Question 39

What is the most common form of pancreatic cancer?

Answer 39

Pancreatic ductal adenocarcinoma (PDA)

Question 40

What causes the biggest increase risk in pancreatic cancer?

Answer 40

Chronic pancreatitis, 18 x increase in risk.

Question 41

What is the commonest pathogenesis of pancreatic ductal adenocarcinomas/ pancreatic cancer?

Answer 41

Pancreatic Intraepithelial Neoplasias (PanIN)

Question 42

How does carcinoma of the head of the pancreas present? (6)

Answer 42

-Jaundice, due to compression of the CBD (common bile duct)
-Weight loss (due to malabsorbtion from exocrine insufficiency)