Gastrointestinal cancers (43) Flashcards
What does primary mean in cancer?
arising directly from the cells in an organ
What does secondary/metastasis mean in cancer?
spread from another organ, directly or by blood or lymph
What tumours do interstitial cells of Cajal give rise to?
gastrointestinal stromal tumours (GISTs)
What tumours do enteroendocrine cells give rise to?
neuroendocrine tumours (NETs)
What tumours do squamous epithelial cells give rise to?
squamous cell carcinomas (SCCs)
What tumours do mucus-producing glandular cells give rise to?
adenocarcinomas
What tumours do smooth muscle tissues give rise to?
leiomyomas/leiomyosarcomas
What tumours do adipose tissues give rise to?
liposarcomas
How does the proportion of muscle types change as the oesophagus descends?
inc. smooth muscle and dec. skeletal muscle
What is squamous cell carcinoma (oesophageal)?
- cancer of normal oesophageal squamous epithelium
- in the upper 2/3
- caused by oxidation of alcohol
- more common in less developed countries
What is adenocarcinoma (oesophageal)?
- cancer of metaplastic columnar epithelium (where there should be squamous instead)
- lower 1/3
- related to acid reflux
- more common in developed countries
What is the progression from acid reflux to cancer?
- oesophagitis (inflammation)
- Barrett’s (metaplasia)
- dysplasia (low–>high grade)
- adenocarcinoma (neoplasia)
What is the 5 year survival for oesophageal cancer?
<20%
What is the management pathway for oesophageal cancer?
- diagnosis by endoscopy–> take biopsy
- staging: CT scan, laparoscopy (to see if spread)
- treatment: curative…neo-adjuvant chemo–> radical surgery
palliative. ..chemo/radiotherapy, stent
What are the forms of colorectal cancer?
- sporadic: absence of family history, older onset, isolated lesion
- familial: family history, younger onset. 1st degree relative
- hereditary syndrome: family history, young, specific gene defects e.g. familial adenomatous polyposis (FAP) and Lynch syndrome
What are the risk factors for colorectal cancer?
- past history
- family history
- diet/environmental
What is the clinical presentation in colorectal cancer by region?
- 2/3 are in descending colon and rectum
- 1/3 in sigmoid colon and rectum
- caecal and right sided cancer presents w/ iron deficiency anaemia, diarrhoea, obstruction, palpable mass
- left sided and sigmoid carcinoma: PR bleeding, mucus, thin stool
- rectal carcinoma: PR bleeding, mucus, tenesmus (need to poo), anal/perineal/sacral pain
- metastases: jaundice, cough, Sister Mary Joseph nodule
- local invasion: bladder symptoms
What are the signs of primary colorectal cancer?
- abdominal mass
- rigid sigmoidoscopy
- abdominal tenderness and distention
What are the signs of metastasis and complications in colorectal cancer?
- hepatomegaly
- bone pain
- monophonic wheeze
What is a colonoscopy?
- can visualise lesions <5mm
- small polyps can be removed–> reduces cancer incidence
- usually performed under sedation
What is CT colonography?
- less invasive than colonoscopy
- can visualise lesions >5mm
- no sedation needed
How is colorectal cancer primarily managed?
surgery
What is the commonest form of pancreatic cancer?
pancreatic ductal adenocarcinoma (PDA)
What are risk factors for pancreatic cancer?
- chronic pancreatitis
- type 2 diabetes
- diet (weak association)
- occupation (insecticides, aluminium etc…)
- cholelithiasis, previous gastric surgery and pernicious anaemia
- cigarette smoking causes 25-30%PDAs
- 7-10% have family history
What inherited syndromes are associated with increased risk of PDA?
- hereditary pancreatitis
- familial atypical multiple mole melanoma
- familial breast-ovarian cancer syndrome
- Peutz-Jeghers syndrome
- Lynch syndrome
- FAP
How does pancreatic cancer develop?
pancreatic intraepithelial neoplasias (PanIN)–> microscopic, not visible by pancreatic imagine
PanIN1–>PanIN2–>PanIN3–>metastasis (this is when it presents)
How does pancreatic cancer present?
- jaundice due to invasion or compression of CBD
- weight loss
- back pain
- acute pancreatitis
- GI bleeding
- carcinoma of body and tail of pancreas often more advanced than lesions in head at diagnosis
What methods can you use to identify/track pancreatic tumours?
- tumour marker CA19-9
- ultrasonography
- dual phase CT
- MRI
- ERCP
- EUS
- PET
What are the types of liver cancer?
- hepatocellular carcinoma
- ChCA
- Gall bladder cancer
- colorectal liver metastases
How do we treat primary liver cancer?
replace liver
