gi cancer Flashcards
what are the two types of oesophageal cancer?
- adenocarcinomas
- squamous cell carcinoma
where do adenocarcinomas occur?
- lower 2/3 of oesophagus
where do squamous cell carcinomas occur?
- upper 2/3 of oesophagus
what are the risk factors for adenocarcinomas?
- barretts oesophagus
- obesity
who is more likely to get adenocarcinomas?
- males
- 60-70
what are the risk factors for squamous cell carcinomas?
- smoking
- alcohol
- nitrous amines
who is more likely to get squamous cell carcinomas?
males
60 - 70
describe the pathology behind oesophageal cancers
- oesophagus lined by squamous epithelium
- stomach lines by columnar glandular epithelium
- oesophagus epithelium undergoes metaplasia to stomach epithelium
what are the early symptoms for oesophogeal cancers?
no symptoms
only presents when advanced
what are the later symptoms for oesophageal cancers?
Anaemia
Loss of weight
Anorexia
Recent sudden symptoms worsen
Melena/ haematemesis
Swallowing progressive difficulty
( if swallowing is NON progressive then suggests achalasia)
REMEMBER IT USING ALARMS
What is melena?
passage of black tarry stools
how are oesophageal cancers diagnosed?
-OGD (oesophago Gastro Duodenoscopy - basically endoscopy) + biopsy
- with barium swallow
-CT/PET
-for staging
how are oesophageal cancers treated?
-if medically fit- chemo/ radio + surgery
- if unfit- palliative care
what are gastric cancers?
stomach cancers
what are most gastric cancers?
adenocarcinomas ( 95%)
what do most gastric cancers involve?
most involve pyloris of stomach
what are type 1 Gastric cancers?
- well differentiated
- better prognosis
- more common
what are type 2 gastric cancers?
- undifferentiated
- signet ring carcinomas
- worse prognosis
who are more likely to get gastric cancers?
- Eastern Europe + Asia
- smoking
- males
- falling incidence
what are the causes of gastric cancers?
- H Pylori
- smoking
- CDH-1 mutation ( mutated cadherin gene- 80% risk)
- pernicious anaemia- autoimmune chronic gastritis
what are the symptoms of gastric cancer?
- severe epigastric pain
· Anaemia
· Weight loss
-Progressive dysphagia ·
Tired all the time
what are the signs of gastric cancer?
Jaundice
↳ liver metastases
Krukenburg tumour
↳ ovarian metastases
Lymph node spread
↳ virchows node - supraclavicular
↳ Sister Mary Joseph node
↳ umbilical
how are gastric cancers diagnosed?
-Gastroscopy + biopsy
· CT/MRI for staging
· PET for metastases
how are gastric cancers treated?
- surgery ( gastroectomy) + ECF chemo regimen
why is there a low chance of small intestine carcinomas?
-as SI is tumour resistant
- most adenocarcinomas
what are the risk factors for small intestine carcinomas?
- chronic SI disease
- crohns, coeliac
how are small intestine carcinomas diagnosed and treated?
same as gastric
what does colorectal polyps and cancer affect?
- large bowel cancer
what are colorectal polyps and cancer usually?
- usually adenocarcinomas
what is the pre cursor for adenocarcinomas?
adenoma
what do adenocarcinomas usually metastases to?
liver and lung
describe the activity of adenocarcinomas
mostly spontaneous and benign but can progress to cancer
who does colorectal polyps and cancer affect?
-60-65
- 3rd most common cancer
- males
describe the pathology behind colorectal polyps and cancer
· Normal epithelium–>
adenoma–>colorectal adenocarcinoma-> metastatic colorectal adenocarcinomas
what are the risk factors for colorectal polyps and cancer?
- Familial adenomatous polyposis
- hereditary non polyposis colorectal cancer
- adenomas/ polyps
- alcohol/ smoking/ UC
how does familial adenomatous polyposis increase risk of colorectal polyps and cancer?
-Autosomal dominant condition
-APC gene mutation -> 1000s of duodenal polyps
- inevitably will get colorectal cancer
how does hereditary non polyposis colorectal cancer increase risk of colorectal polyps and caner?
Autosomal dominant condition
MSH-1 mutation : DNA mismatch repair gene
rapidly increases progression of cancer
what are the symptoms of colorectal polyps and cancer?
- mostly in distal colon
- LLQ pain
- bloody mucus stools
- tenesmus
how are colorectal polyps and cancer diagnosed?
- FIT test (faecal immunological test) ↳ screening for micro blood particles in poo
- Colonoscopy + biopsy
- classification -> T N M staging
how are colorectal polyps and cancer treated?
surgery and chemo
