gi cancer Flashcards
what type of cancer can squamous cells become?
scc and adenoma
what are enteroendocrine cell cancers called?
neuroendocrine tumours
what are cancers of the interstitial cells of cajal called?
gastrointestinal stromal tumours (gists)
what is an adipose cancer called?
liposarcoma
what type of cell becomes squamous cell carcimoma in the oesophagus?
stratified squamous epithelium
what is scc (oesophagus) associated with?
alcoholism
what type of cells form adenocarcimona of the oesophagus?
metaplastic columnar epithelium
3 stages of progression from reflux to oesophageal cancer?
oesophagitis, barrett’s, adenocarcinoma
how is barrett’s survaillance?
no dysplasia
mild dysplasia
high dysplasia
2-3 years
6 months
intervention
2 key symptoms of oesophageal adenocarcinoma?
dysphagia and weight loss
how is oesophageal cancer diagnosed?
endoscopy and biopsy
how is it staged?
ct
laparoscopy
eus
pet scan
treatment plan for curative oes. cancer?
neoadjuvant cx and oesophagectomy
3 aspects of palliative oesophageal treatment?
chemo, radiotherapy, stent
what approach is taken for the oesophagectomy?
ivor lewis approach
3 forms of colorectal cancer?
sporadic, familial, hereditary
2 heredetroy synromes that increase risk of crc?
FAP, HNPCC (lynch syndrome)
what do prophylactic endoscopies look for
polyps
what can prevent progression of polyps?
asprin, nsaids, folate, calcium
4 past history rfs for crc?
colorectal cancer, polyps, ulcerative colitis, radiotherapy
4 lifestype factors that can increase crc risk>
carcinogenic foods, smoking, obesity, socioeconomic status
how does caecal/right sided cancer present?
iron deficiency anaemia
change in bowel habits
palpable mass
ileal obstruction
how does left sided/sigmoid carcinoma present?
PR bleeding
mucus in stool
thin stool
how does rectal cancer present
PR bleeding, mucus, tenesmus, anal pain
what other symptoms may crc present with?
liver mets - jaundice, hepatic pain
lung mets - cough
what is the sister mary joseph nodule indicative of?
peritoneal mets
4 aspects of physical exam for crc?
pr exam
palpable mass
tenderness
rigid sigmoidoscopy
2 faecal occult blood tests to do?
guaiac test
FIT
what advice to give before suaiac test?
avoid red meat, melons, horse radish, vit c and nsaids for 3 days before
what is looked for in a blood test for crc
anaemia, low ferratin
CEA tumour marker
imaging for crc?
colonoscopy ct colonoscopy (elderly, unfit)
when is an MRI pelvis done?
rectal cancer
shows mesorectal lymph node involvement
decides if chemo first or surgery
how is a right/transverse carcinoma surgically treated?
resection (hemicolectomy/extended hemicolectomy) and primary anastoomosis to ileum
how is a left sided obstruction treated?
- hartmann’s procedure - proximal end colostomy then anastamose in 6 months
- resect and anastomose directly
- ileostomy
risk factors for pancreatic cancer?
chronic pancreatitis t2dm gallstones diet cigarettes family history
risk factors for pancreatic cancer?
chronic pancreatitis t2dm gallstones diet cigarettes family history
which inherited syndromes increase risk for pancreartic cnacer?
hereditoray pancreatitis
family atypical multiple mole melanoma
lynch syndrome
fap
what are PanINs? how are they visable?
pancreatic intraepithelial neoplasias (like polyps for bowel). only visable microscopically. acquire genecic alterations along way
clincial presentation for cancer in head of pancreas?
jaundice, weight loss, epigastric pain, acute pancreatitis, vomiting, gi bleeding
what pain is a bad sign in pancreatic cancer?
epigastric pain that radiates to back - shows capsule invasion and irresectability
why is cancer of the tail of the pancreas worse?
develops insidiously and presents late
most common symptoms of pancreas tail cancer? what is not seen?
weight loss and back pain
no jaundice
what tumour marker is there for pancreatic cancer? what can falsely raise it?
CA19-9
PANCREATITIS, obstructive jaundice
investigations for pancreatic cancer?
- dual phase CT
ercp (double duct sign, theraputic)
eus (small tumours)
pretty much all
what must be taken out in a top resection?
spleen due to splenic artery
what is hepatocellular cancer associated with?
cirrhosis
treatment for hepatocellular cancer?
surgical excision
liver transplant
radiofrequency ablation
transarterial chemo embolisayion
3 causes of gallbladder cancer?
gallstones, porcelain gallbladder, chronic typhoid infection
3 causes of cholaniocarcimoma?
primary sclerosing cholangitis
liver fluke
choledochal cyst
optimal treatments for all liver cancers?
surgical excision with curative intent
