GI cancer

Question 1

What are the different types of upper GI cancers

Answer 1

• Oesophogeal
• Gastric
• Liver
• Pancreas
• Gall bladder
• Small intestine

Question 2

How do upper GI cancers clinically present

Answer 2

• Anorexia
• Unintentional weight loss
• Dysphagia
• Epigastric mass
• Recent onset dyspepsia if >55
• Persistent vomiting
• Iron deficiency anaemia

Question 3

What are the different types of lower GI cancers

Answer 3

• Colorectal

- Anus

Question 4

How do lower GI cancers clinically present

Answer 4

• Abdominal pain
• Change of bowel habit
• Passing of mucus
• Blood in stool/rectal bleeding
• Anaemia
• Intestinal obstruction
• Palpable mass in abdomen

Question 5

What are the risk factors of GI cancers

Answer 5

- Familial link
Aspirin/NSAID use 
Menopausal HT
Statin use
Ethnicity 
Male 
T2DM
IBD

Question 6

Which modifiable risk factors increase the risk of GI cancers

Answer 6

Smoking
processed meat
alcohol intake 
red meat
low intake of veg and fruit 
body fat and obesity

Question 7

Which modifiable risk factors decrease the risk of GI cancers

Answer 7

Exercise 
whole grains 
fibre
dairy products
fish intake
nuts
vit D, C etc
Calcium supplements

Question 8

How to screen for GI cancers

Answer 8

Faecal Immunochemical test

• detects v small amounts of blood in faeces using antibodies specific to human haemoglobin
• offered every 2 years to asymptomatic men and women aged 60-74
• positive test - refer for colonoscopy

UK flexible sigmoidoscopy screening
- detects bowel polyps and cancers early before symptoms develop

Question 9

What investigations can be taken

Answer 9

clinical history
colonoscopy
biopsy
imaging - CT abdomen, thorax, pelvis
Tumour markers

Question 10

what is the TNM staging for GI cancers?

Answer 10

T1 = tumour in inner layer of bowel
T2 = grown into muscle layer of bowel wall
T3 = grown into outer lining of bowel wall
T4 = grown through outer lining - other parts/nearby organs/broken through membrane covering outside of bowel (peritoneum)

N0 = No lymph nodes containing cancer cells
N1 = 1-3 lymph nodes close to bowel contain cancer cells
N2 = cancer cells in 4 or more nearby lymph nodes

M0 = no spread to other organs
M1 - spread to other parts of the body

Question 11

How does the location of the cancer effect prognosis

Answer 11

right hand side = worse prognosis
involves the transverse colon, ascending colon and cecum
associated with mutations in checkpoints

left hand side = better prognosis
involves descending colon, sigmoid colon, rectum
genetic mutations more susceptible to certain treatments (EGFR)

Question 12

Describe the staging of dukes classification

Answer 12

stage A = T1-T3
stage B = T4, N0
stage C = N1, N2, M0
stage D = M1

Question 13

What is the enhanced recovery after surgery (ERAS) programme

Answer 13

For colorectal cancer, it involves:

• Post op education and counselling
• Optimising post op nutritional status
• Anaesthetic
• Early enteral feeding
• Optimal post op analgesia
• prep for stoma
• Abx prophylaxis
• TE prophylaxis

Question 14

What are the complications of a stoma?

Answer 14

Leakage 
infection
Haemorrhage 
VTE 
longer term = urinary incontinence, sexual and bowel dysfunction