Gastrointestinal Cancers Flashcards
Describe the incidence of various common cancers of the G.I. tract
- Bowel/colorectal cancer 4th most common cancer
- Other common caners include pancreas, oesophagus, stomach and liver
State the type of cancer in oesophageal cancer
- Squamous cell carcinoma
- Lower third can develop adenocarcinoma - Barrett’s oesophagus
Describe the presentation of oesophageal cancer
- Progressive dysphagia, red flags of dysphagia (ALARM):
- Anaemia
- Loss of weight
- Anorexia
- Recent onset of progressive symptoms
- Masses/malaena
State he risk factors and investigation for oesophageal cancer
- Risk factors - smoking, obesity, Barrett’s
- Barium swallow shows narrowing of oesophagus
- Endoscopy can confirm diagnosis
Describe the type and location of gastric caner
Typically adenocarcinomas in the cardia or antrum
Describe the presentation of gastric cancer
- Epigastric pain
- Similar pain to peptic ulcer
- Malaena - metabolism of blood from the upper GI tract
- Haematemesis
- Generally present late and therefore more advanced
Describe the risk factors of gastric cancer
- Risk factors - smoking, high salt diet, family history
- Chronic inflammation increases risk of malignancy - H. pylori infection
Other than gastric cancer, describe other stomach cancers
- Gastric lymphoma - MALT tissue
- Similar presentation to gastric carcinoma
- Most associated with H. pylori
- Better prognosis than gastric carcinoma
- Gastrointestinal stromal tumours (GIST)
- Sarcomas - not epithelial
Describe the causes of liver carcinoma
- Primary malignancy very rare - hepatocellular carcinoma
- Linked to underlying disease - alcoholic hepatitis, viral hepatitis
- Most spread through the blood (haematological), lymphs or through cavities (transcolemic)
- Common primary sites include: colon, breast, prostate, gastric, oesophageal
Describe the presentation of liver carcinoma
- Jaundice
- Hepatomegaly - irregular border common in metastases
- Ascites
- Painless
- Unintentional weight loss
- Pruritis
Describe the presentation of pancreatic cancer
- Head: painless jaundice, weight loss, anorexia, fatigue
- Body/tail: symptoms more vague - malabsorption, epigastric pain
- 80% ductal adenocarcinomas
- Enlarged, palpable, non-tender gall bladder - cause not from gall stones and could be cancer
Describe the risk factors of pancreatic cancer
- Family history, smoking
- Men more affected, incidence increases with age
- Chronic pancreatitis
Describe the risk factors of large bowel cancer
- Family history
- Inflammatory bowel disease
- Polyposis syndromes (familial adenomatous polyposis)
- Diet and lifestyle - rich in meat and processed food
Describe the screening of large bowel cancer
- Aged 60-74 every 2 years
- Faecal occult blood - test for non-visble bleeding where positive results should be further investigated
Describe the presentation of large bowel cancer
- Right sided colon cancer - weight loss, anaemia, occult bleeding
- Present later as caecum and ascending colon are more distensible
- Left sided - more obstructive symptoms including constipation, abdominal pain, tenesmus, change in bowel habit, rectal bleeding, weight loss
- Rectal cancer - rectal bleeding, tenesmus, weight loss
Describe the risk factors of small bowel cancer
IBD, coeliac disease, diet, polyposis syndromes
Describe the presentation of small bowel cancer
Weight loss, colicky abdominal pain (every 3-5 minutes), blood in stools
Describe GI cancer management
- TNM staging
- Blood test - FBC (iron deficient anaemia), tumours markers (CEA suggests colon cancer)
- CT/MRI
- Endoscopy/colonoscopy
- Capsule endoscopy to look at small bowel - camera swallowed
- Treatment - chemotherapy, radiotherapy, surgical resections
Describe the type of cancer in GI cancers
- Most cancers are adenocarcinomas
- Oesophageal cancers and anal cancers are squamous cell carcinomas
Describe the adenoma-carcinoma sequence relating to colorectal cancer
- Benign growth of polyps (adenomas) from genetic changes may become hyperplastic and develop into adenocarcinomas
- Due to activation of oncogenes, ineffective DNA repair, loss of tumour suppressor genes
Describe the differential diagnosis of epigastric pain
Oesophageal varices, acute gastritis, gastric ulcer, duodenal ulcer
Describe the different types of per rectum bleeding
- Fresh red bleeding - bleeding low in GI tract - rectum
- Bleeding with stools - infective such as inflammatory bowel disease
- Malaena - bleeding higher up
- Tenesmus - incomplete emptying, rectal pain - inflammatory bowel disease
Describe the differential diagnosis of per rectum bleeding
Haemorrhoids, anal fissures, infective gastroenteritis, IBD, diverticular disease, adenocarcinoma of large colon, small bowel cancer
Describe the differential diagnosis of changes in bowel habit
- Thyroid disorder, IBD, medication related, IBS, coeliac disease, adenocarcinoma of large bowel, small bowel cancer
- Hyperthyroid may present with looser stools while hypothyroidism may present with constipation
