Gastrointestinal cancers Flashcards
CRC incidence
2nd most common new cancer
3rd most common cancer death
> 50% in >70yrs of age
Curable when localised
5yr survival 63%
Staging of CRC
Dukes 1 = Submucosal 2 = through serosa 3 = regional lymph nodes 4 = distant mets
Prognostic factors of CRC
DEPTH OF PENETRATION- deeper = poorer Serosal involvement = poor LN involvement = poor Distant mets = poor Bowel obstruction/perforation Extramural LVI
MSI = improved survival
Risk factors CRC
Age >50yrs Family history Poor intake of fruits and vegetables EtOH Obesity T2DM IBD
Familial CRC?
FAP:
- APC germline mutation
- <1% of CRCs
- CRC by 45yrs
HNPCC:
- Defects in mismatch repair genes - MSH2 and MSH6, MLH1 and MLH3, PMS1 and PMS2
- 2-4% of CRC
- CRC and endometrical cancer
Screening for low risk:
- asymptomatic individuals without personal history of IBD or CRC or family history of CRC
98% of population
FOBT every 5yrs from 50yrs
Screening for moderately increased risk:
- 1st degree relative <55yrs CRC
- 2 relatives with CRC any age
5yrly Colonoscopy from 50yrs OR 10yrs younger than 1st diagnosis of CRC
Screening for high risk:
- > 3 relative with CRC
- > 2 relative and multiple CRCs in 1 person
- CRC <50yrs and endometrial or ovarian cancer
- Suspected FAP in family
- Suspected HNPCC in family
Need genetic counseling ? FAP or HNPCC
FAP:
- Sigmoidoscopy from 12yrs
- Colectomy 25yrswith duodenal screening yrly
HNPCC:
- Colonoscopy yrly from 25yrs
Adjuvant chemotherapy
If lymph node disease present = Chemotherapy
5FU or capecitabine +oxaliplatin
5FU
5-Fluorouracil
Antimetabolite - pyrimidine analogue
Given with folinic acid
Side effects:
- Lethargy, N+V
- Cardiac toxicity - coronary vasospasm
- Diarrhoea
- Mucositis
- Palmar and plantar erythema
Worse is dihydropyrimidine dehydrogenase deficit
Capecitabine
Fluoropyrimidine
Similar side efects to 5FU but more palmar plantar erythema
Oxaliplatin
Platinum derivative
Side effects:
- Lethargy
- N+V+D
- Myelosuppression
- Peripheral neuropathy
Treatment for metastatic CRC
Chemotherapy - 5FU/capecitabine+oxaliplatin
K-RAS wild type = Bevacizumab and chemotherapy
Fail 1st line and K-RAS wildtype = Cetuximab +/- chemo
Liver metastasis in CRC
If liver only mets = resect
Neo-adjuvant chemo may result in resectable margins
Rectal cancer treatment
Neoadjuvant chemo and radio
Surgery
Gastric cancer risk factors
High intake of salt and salt preserved foods Low consumption of fruits and vegetables H. pylori Smoking Obesity GORD
1-3% hereditary diffuse cancers
Gastric cancer incidence
Rare <50yrs
2nd leading cause of cancer mortality worldwide
Tend to present late
5yr survival 25%
> 90% are adenocarcinomas
Gastric cancer treatment
Radical surgery with adjuvant chemo and radiotherapy
Metastatic disease = chemo
If HER2+ = trastuzumab and chemo
