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BRS Y2 > Gastrointestinal Cancers > Flashcards

Gastrointestinal Cancers Flashcards

1
Q

Define cancer

A

A term for diseases in which abnormal cells divide without control and can invade nearby tissues

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2
Q

What is a primary cancer?

A

A cancer arising directly from cells in the organ

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3
Q

What is a secondary cancer?

A

A cancer that spreads from another organ, directly or by other means (blood or lymph)

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4
Q

What are the 6 main hallmarks of cancer?

A 
Sustaining proliferative signalling
Evading growth suppressors
Activating invasion and metastasis
Enabling replicative immortality
Inducing angiogenesis
Resisting cell death
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5
Q

What are the epithelial cell GI cancers?

A

Squamous cell carcinoma

Adenocarcinoma

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6
Q

What are the neuroendocrine GI cancers?

A

Neuroendocrine tumours

Gastrointestinal stromal tumours

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7
Q

What are the connective tissue GI cancers?

A

Leiomyoma/leiomyosarcoma

Liposarcoma

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8
Q

Where in the GI tract do neuroendocrine tumours occour?

A

Anywhere along the tract

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9
Q

Define cancer screening

A

Testing of asymptomatic individuals to identify cancer at an early stage

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10
Q

What criteria is used to decide if it is useful to screen for a disease?

A

Wilson Junger criteria

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11
Q

How is screening for colorectal cancer carried out?

A

FIT= faecal immunochemical test which detects haemoglobin in the faeces
One off sigmoidoscopy

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12
Q

How is screening for oesophageal cancer carried out? And for which patients?

A

Regular endoscopy for patients with Barrett’s oesophagus, low or high grade dysplasia

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13
Q

How is screening for pancreatic and gastric cancer carried out?

A

No test currently as it doesn’t meet the W & J criteria

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14
Q

How is screening for hepatocellular cancer carried out?

A

Regular ultrasound and AFP for high risk patients and those with cirrhosis

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15
Q

What is the first step in a cancer journey?

A

Presenting to the GP with symptoms or being identified via a screening programme

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16
Q

What happens after cancer is initially suspected?

A

Patients are referred via 2 week wait pathway

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17
Q

In the cancer MDT what is role of pathologist?

A

Confirm cancer diagnosis using biopsy samples
Provide histological typing eg where does the cancer come from
Provide molecular typing eg what mutations does the cancer have
Provide the tumour grade

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18
Q

In the cancer MDT what is role of radiologist?

A

Review scans
Suggest other imaging to clarify diagnosis
Decide if a biopsy needs to be performed and where
Provide tumour stage
Re staging after treatment

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19
Q

In the cancer MDT what is role of surgeon?

A

Decide if surgery is appropriate

Perform operation and care for patient after the operation

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20
Q

In the cancer MDT what is role of gastroenterologist?

A

Endoscopy, either diagnostic or therapeautic

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21
Q

In the cancer MDT what is role of oncologist?

A

Decides on whether chemotherapy, radiotherapy or other systemic therapy is appropriate
Co ordinates overall treatment plan

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22
Q

What is the major driver for gastric adenocarcinoma?

A

Chronic gastritis due to chronic acid overproduction

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23
Q

Describe the pathogenesis of gastric adenocarcinoma

A

Chronic gastritis, intestinal metaplasia, dysplasia and malignancy

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24
Q

What is the main symptom gastric adenocarcinoma presents with?

A

Dyspepsia (upper abdominal discomfort after eating or drinking)

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25
Q

What acronym is used to remember red flags of gastric adenocarcinoma and what does it stand for?

A 
ALARMS55
Anaemia
Loss of weight or appetite
Abdominal mass on examination
Recent onset of progressive symptoms
Melaena or haematemesis
Swallowing difficulty
55 years and above
26
Q

How is gastric adenocarcinoma diagnosed?

A

Via endoscopy or biopsy

27
Q

How is gastric adenocarcinoma treated if the tumour is close to the OG junction?

A

Total gastrectomy (the sphincter mechanism cannot be saved)

28
Q

How is gastric adenocarcinoma treated if the tumour is at the OG junction?

A

Oesophago-gastrectomy

29
Q

How is gastric adenocarcinoma treated if the tumour is far from the OG junction?

A

Subtotal gastrectomy

30
Q

What types of chemotherapies can be used for gastric adenocarcinoma?

A 
Neoadjuvant= to shrink tumour before surgery
Adjuvant= needed in advanced tumours to reduce risk of relapse
31
Q

Where do neuroendocrine tumours arise from?

A

The gastreoenteropancreatic tract (stomach, bowel, pancreas) or from the bronchopulmonary system

32
Q

How do NETs present?

A

Most are asymptomatic and found incidentally

33
Q

What may NETs detrimentally secrete?

A

Hormones (and their metabolites), mainly serotonin

34
Q

What syndrome occurs when NETs secrete serotonin?

A

Carcinoid syndrome

35
Q

What is required for carcinoid syndrome to arise?

A

Liver mets as without these the liver would metabolise the excess serotonin

36
Q

What occurs in carcinoid syndrome?

A 
Vasodilation causing face flushing
Bronchoconstriction
Increased intestinal motility causing diarrhoea
Endocardial fibrosis (particularly right sided)
37
Q

What are the 2 results of a pancreatic cancer?

A

Insulinoma

Glucagonoma

38
Q

What are clinical features of insulinoma?

A

Hypoglycaemia

Whipples triad

39
Q

What is Whipple’s triad?

A

A set of criteria that indicates someone is suffering from hypogylcaemia:
Has symptoms of hypoglycaemia
Symptoms are relieved by giving IV glucose
Fasting hypoglycaemia

40
Q

What are clinical features of glucagonoma?

A

Diabetes mellitus

Erythema

41
Q

What is insulinoma often misdiagnosed as?

A

Epilepsy because when blood sugar is low they faint and have seizures, their partners may also think they are drinking as hypoglycaemia makes you act like you are drunk

42
Q

How are NETs diagnosed?

A

Biochemical assessment

Imaging eg CT/MRI

43
Q

How are NETs graded?

A

By their mitoses and Ki-67 index

44
Q

Where do GEP NETs most commonly metastasise?

A

Small intestine, pancreas and colon

45
Q

How are NETs treated?

A

Mainly via resection
May need liver transplant if their are mets
Embolisation, medical therapy, targeted therapy or biotherapy may also be done

46
Q

What are structural causes of upper dysphagia?

A

Pharyngeal cancer

Pharyngeal pouch

47
Q

What are neurological causes of upper dysphagia?

A

Parkinson’s
Stroke
Motor neuron disease

48
Q

What are structural causes of lower dysphagia?

A

Inside (mural and luminal): oesophageal or gastric cancer, stricture, Schatzki ring (hypertrophy of mucosa)
Outside (extrinsic compression): lung cancer

49
Q

What are neurological causes of lower dysphagia?

A

Achalasia

Diffuse oesophageal spasm

50
Q

How can we differentiate between angina and dysphagia?

A

Angina can occour after meals but will also usually occour after exertion
Dysphagia will also cause discomfort seconds after swallowing

51
Q

How do you differentiate between upper or lower oesophageal dysphagia?

A

If food is painful on swallowing its upper

If food is easy to swallow but feels stuck seconds later its lower

52
Q

How do you differentiate between mechanical and neurological causes of dysphagia?

A

If both liquids and solids are hard to swallow its likely neurological

53
Q

What can you ask to determine if the patient is at risk of strictures?

A

History of reflux

54
Q

What happens to albumin levels in anorexia?

A

May be low/slightly low

55
Q

What are causes of microcytic anaemia?

A

Iron deficiency
Anaemia of chronic disease
Thalassaemia
Sideroblastic anaemia

56
Q

What are causes of normocytic anaemia?

A 
ABCDE:
Aplastic anaemia
Bleeding
Chronic disease
Destruction (haemolysis)
Endocrine disorders (hypo or hyperthyroidism)
57
Q

What are causes of macrocytic anaemia?

A 
FAT RBC
Foetus (pregnancy)
Alcohol excess
Thyroid disorders
Reticulocytosis
B12/folate deficiency
Cirrhosis
58
Q

What are some common GI causes of iron deficiency anaemia?

A

Aspirin/ NSAID use
Colonic adenocarcinoma
Gastric carcinoma
Benign gastric ulcer

59
Q

What symptoms suggest colorectal cancer?

A

Change in bowel habit
Blood or mucus in stool
Faecal incontinence
Tenesmus

60
Q

What is done to ensure the patient hasn’t missed blood in stool or urine?

A

Digital rectal exam

Urine dipstick test

61
Q

How are cancers of the colon treated?

A

Via surgery to do resection

Accompanied by aggressive chemo and aggressive treatment in general as there are high rates of survival

BRS Y2 (85 decks)

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