Gastrointestinal Cancers

Question 1

What are the two types of oesophageal cancer? Where are they more common?

Answer 1

Squamous cell- upper 2/3s of oesophagus
Adenocarcinoma- lower 1/3rd of oesophagus

Question 2

What are risk factors for squamous cell oesophageal cancer?

Answer 2

Smoking, excessive alcohol consumption

Question 3

What are risk factors for adenocarcinoma of the oesophagus?

Answer 3

Long standing GORD, obesity and high fat intake

Question 4

What is usual pathophysiology of adenocarcinomas of the oesophagus?

Answer 4

Barretts oesophagus (metaplasic epithelium) following GORD, which progresses to dysplasia and eventually become malignant

Question 5

What a are some symptoms of oesophageal cancer?

Answer 5

Progressive dysphagia, weight loss, odynophagia, hoarseness (RLNerve involvement), hiccups (phrenic nerve involvement), paroxysmal/sudden cough (implies fistula)

Question 6

What are current red flag symptoms that meet criteria for urgent endoscopy for suspected oesophageal malignancy?

Answer 6

Any patient with dysphagia
Any patient >55y/o w weight loss and upper abdo pain, dyspepsia or reflux

Question 7

How is suspected oesophageal cancer investigated?

Answer 7

Endoscopy is first line with biopsy
If not possible then CT neck and thorax can be done, but not as accurate

Question 8

What are palliative management options for oesophageal cancer?

Answer 8

Stenting, palliative radio/chemotherapy to reduce tumour size, nutritional support, thickened fluids, gastrostomy

Question 9

What is the most common type of gastric cancer (>90%)?

Answer 9

Adenocarcinoma from gastric mucosa

Question 10

What a re risk factors for gastric adenocarcinoma?

Answer 10

Male, increasing age, smoking, alcohol, H.pylori infection, salty diet, family history and pernicious anaemia

Question 11

What are common presenting symptoms of gastric cancer?

Answer 11

Dyspepsia (new onset/unresponsive to PPIs), dysphagia, early satiety, vomiting, melena.
Symptom are vague and non-specific so pts present at late stage. Anorexia, weight loss or anaemia or markers of late disease

Question 12

What is Troisier sign?

Answer 12

Presence of palpable left supraclavicular node (Virchows node) and is a sign of metastatic abdo malignancy

Question 13

What investigation will be done if suspecting a gastric cancer?

Answer 13

Upper GI endoscopy with biopsy, urea breath test, HER2 expression test

Question 14

What are management options for gastric cancer?

Answer 14

Nutritional support (NG, RIG tubes), gastrectomy with 3 cycles of neo-adjuvant chemo and 3 cycles adjuvant chemo peri-operatively

Question 15

What is dumping syndrome following gastric surgery?

Answer 15

Sudden large passage of hypertonic gastric contents into small intestine, resulting in intraluminal fluid shift and subsequent intestinal distention.
Surge in insulin production following dumping of food results in hypoglycaemia

Question 16

What is the double duct sign on MRCP? What diagnosis does it increase the likelihood of?

Answer 16

dilation of both the common bile duct and pancreatic duct, likely caused by pancreatic cancer

Question 17

what does Courvoisier’s sign state?

Answer 17

in a patient with a painless, enlarged gallbladder and mild jaundice the cause is unlikely to be gallstones, it is more likely to be a malignancy of the pancreas or biliary tree

Question 18

what does a raised ESR and osteoporosis represent until proven otherwise?

Answer 18

multiple myeloma