GI cancer

Question 1

upper GI cancers

Answer 1

mainly adenocarcinomas from lower oesophagus downwards
squamous cell carcinoma, upper/mid 
GI stromal tumours
lymphoma
mets

Question 2

achalasia:

Answer 2

failure of lower oesophageal sphincter to open when eating, causing food to get ‘stuck’. increased Ca risk

Question 3

TNM staging

Answer 3

primary tumour invades:
T1 lamina propria/submucosa
T2 muscularis propria
T3 adventitia
T4 adjacent structures

Regional LNs (N)
N1 1/2 nearby nodes
N2 3-6 nearby nodes
N3 >7 nearby nodes

Mets
M0 none
M1 distant spread

Question 4

pathology of gastric cancers

Answer 4

adenocarcinomas (90%)
lymphomas (up to 8%)
leiomyosarcomas (1-3%)
GI stromal tumours

Question 5

cholangiocarcinoma

Answer 5

cancer of the biliary tree
idiopathic or a complication of primary billiary cirrhosis
presents with painless obstructive jaundice

Question 6

clinical presentations of colorectal cancer

Answer 6

right sided: Fe deficiency anaemia, palpable mass
Left sided: change in bowel habit, rectal bleed
Rectum: PR bleed, tenesmus
(+ all cancer red flags for all)

Question 7

carcinoembryonic antigen is raised in which type of cancer?

Answer 7

Raised in 85% of patients with colorectal cancer. higher value is associated with a worse prognosis

Question 8

Dukes staging

Answer 8

A: in situ
B1: into, but not beyond muscularis propria, no LN
B2: through muscularis propria, no LN
C1: LN positive, but not apical 
C2: apical node positive
D: Mets

Question 9

CRC prognosis according to dukes

Answer 9

A: 95%
B: 70-80%
C: 40%
D: 5%

Question 10

CRC prognosis according to TNM staging

Answer 10

I: 95%
II: 70-80%
III: 40%
IV: 5%

Question 11

screening methods in CRC

Answer 11

faecal occult blood test
flexi sigi
colonoscopy
(recommend screeining between 50-75 years old)