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year 1 > GI - cancer > Flashcards

GI - cancer Flashcards

1
Q

what is the most common type of oesophageal cancer in europe

A

adenocarcinoma

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2
Q

what is an adenocarcinoma

A

malignant proliferation of gland cells

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3
Q

what is the most common oesophageal cancer world wide

A

squamous cell carcinoma

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4
Q

what are some risk factors for adenocarcinoma

A 
Barrett's oesophagus
caucasian
male
obesity
H Pylori
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5
Q

where is adenocarcinoma usually seen and why

A

lower 1/3 oesophagus

reflux insult is greatest here

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6
Q

what is a squamous cell carcinoma

A

malignant proliferation of squamous cells

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7
Q

where is squamous cell carcinoma usually seen in oesophagus

A

middle/upper 1/3 oesophagus

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8
Q

what are some risk factors for squamous cell carcinoma

A 
GORD ---> dysplasia ---> SCC
male
alcohol
tobacco
hot tea
achalasia
oesophageal web
vit A/zn deficiency
HPV
oesophagitis
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9
Q

what are the 3 investigations done for oesophageal cancer

A

endoscopy + biopsy
Ba swallow
CT scan for staging
U/S

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10
Q

what 3 ways can oesophageal cancer spread

A

direct invasion
lymphatic
haematogenous

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11
Q

what is the only chance of cure in oesophageal cancer

A

surgery - only 50% suitable

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12
Q

when is surgery contraindicated in oesophageal cancer

A

direct invasion of adjacent structures
widespread mets
poor health

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13
Q

s/s oesophageal cancer

A

progressive dysphagia (solid –> liquid)
weight loss
pain
haematemesis

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14
Q

why might SCC present with hoarse voice and cough

A

hoarse voice - recurrent laryngeal nerve involvement

cough - trachea involvement

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15
Q

what is the most common benign oesophageal cancer

A

squamous papilloma

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16
Q

what is the most common oral cancer

A

squamous cell carcinoma

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17
Q

what is the most common location of oral cancer

A

floor of mouth and lateral borders of tongue

other locations - soft palate, ventral tongue and borders
rare - hard palate, dorsum of tongue

anterior lesions have a better prognosis than posterior

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18
Q

true/false
squamous cell carcinomas of oral cavity are cytologically malignant neoplasms of squamous epithelial cells lining oral mucosa and all show invasion and destruction of local tissues

A

true

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19
Q

what is the treatment of oral cancer

A

surgery +/- radio/chemo as adjuvant

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20
Q

name 2 precursor lesions of squamous cell carcinoma

A

leukoplakia

erthyroplakia

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21
Q

what is a leukoplakia

A

premalignant lesion
oral mucosal white patch that doesn’t rub off
often represents squamous cell dysplasia

think leuko - white blood cell - white

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22
Q

what is an erthyroplakia

A

red plaque - represents vascularised leukoplakia
highly suggestive of squamous cell dysplasia
indicative of malignancy

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23
Q

s/s oral cancer

A 
red/white lesions
change in voice
dysphagia
lesions tend to be numb - painful in late manifestation
unexplained pain in mouth/neck
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24
Q

define kaposis sarcoma

A

proliferating spindle cells (usually mouth/nose/throat)

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25
what are 2 types of benign gastric lesions
hyperplastic polyp | cystic fundic gland polyps
26
what is a more common gastric carcinoma - intestinal or diffuse type which has better prognosis
intestinal | intestinal
27
what are some risk factors for oral cancer
``` tobacco alcohol age men > women HPV - oropharyngeal cancer Vitamin A and C deficiency ```
28
where do adenocarcinomas of the stomach most commonly occur
proximally - GO junction, cardia | linked to H. Pylori
29
what are some s/s of gastric cancer
``` weightless abdominal pain anaemia early satiety jaundice abdominal mass loss of blood ```
30
what type of gastric cancer is "large, irregular ulcer at lesser curvature"
intestinal carcinoma
31
what are some risk factors for intestinal type carcinoma
H. Pylori Autoimmune Gastritis nitrosamines in smoked foods Blood type A
32
how does chronic gastritis cause intestinal type carcinoma
chronic gastritis ---> intestinal metaplasia/atrophy --> dysplasia ---> carcinoma
33
what type of cancer is "signet ring cells" and "desmoplasia with thickening in stomach wall"
diffuse type
34
is Diffuse type carcinoma associated with H. Pylori, intestinal metaplasia or nitrosamines?
no
35
what are 3 investigations done for gastric cancer
gastroscopy + biopsy Ba swallow CT scan
36
what is the typical surgical treatment of proximal lesions in gastric cancer
total gastrectomy
37
what is the typical surgical treatment of distal lesions in gastric cancer
partial gastrectomy
38
in gastric carcinomas is treatment curative
no, palliative
39
what can be seen if gastric cancer spreads to lymph nodes
Virchow's node - left supraclavicular node
40
where are distant mets most common to
liver
41
is pernicious anaemia pre malignant
yes
42
what are some other types of malignant gastric cancers
lymphomas, GIST, Maltoma
43
what does GIST stand for
Gastrointestinal stromal tumour may be benign or malignant and are most commonly in STOMACH and small intestine linked to ICC mesenchymal tumour
44
what does MALT stand for
Mucosa associated lymphoid tissue - derived accoc. H Pylori involve B cells
45
what is the most common cancer of the appendix
carcinoid tumour - causes intussusception and obstruction
46
where does a carcinoid tumour arise from
crypts of lieberkuhn
47
what does a carcinoid tumour look like
brown-yellow nodule
48
what is the treatment for an appendix tip tumour
appendicectomy
49
what is the treatment for an appendix base tumour
right helicolectomy
50
what is carcinoid syndrome
``` liver metastases of appendix carcinoid tumour release serotonin (5HT) - paraneoplastic ```
51
what are some s/s or carcinoid syndrome
facial flushing diarrhoea bronchospasm hypotension
52
what is an investigation for carcinoid syndrome
urinary 5-HIAA
53
what are some s/s of pancreatic cancer
``` jaundice (dark urine, light stools) weight loss anorexia nausea and vomitng back pain abdominal pain ```
54
what are some risk factors of pancreatic cancer
``` smoking charred meat obesity physical inactivity diabetes ```
55
what is the investigation for pancreatic cancer
CT
56
what staging is used for pancreatic cancer
TNM
57
what treatment is used if a pancreatic cancer is resectable
whipple resection or total/distal pancreatectomy
58
what treatment is used if a pancreatic cancer isn't resectable
biliary/gastric bypass
59
what is the most common type of exocrine cancer
adenocarcinoma - can't be resected located in head body or tail causes bile duct obstruction
60
what are 3 types of endocrine cancers
gastrinoma - release gastrin - increased stomach acid - gastric/duodenal ulcers insulinoma - release insulin - body stores sugar - hypoglycaemia glucagonoma - release glucagon - hyperglycaemia
61
if a solid malignant lesion is found in an older patient's liver is it more likely to be primary or secondary
secondary
62
is a solid lesion in a cirrhotic liver more likely to be primary or secondary
primary
63
what are 3 benign liver lesions
hemangioma Focal nodular hyperplasia Hepatic Adenoma
64
what is the most common liver tumour
hemangioma
65
are men or women more prone to hemangioma
women
66
how do you describe a hemangioma
hypervascular | single, small, well demarcated capsule
67
what does a hemangioma look like on US
well demarcated echogenic spot
68
who is most prone to focal nodular hyperplasia
young middle aged women
69
what is the histology of a focal nodular hyperplasia
central scar containing large artery with radiating branches (hub and spoke) sinusoids, bile ducts and kupffer cells all present
70
what is a focal nodular hyperplasia
hyper plastic response to abnormal blood flow e.g. congenital vascular abnormality
71
what is adenomatosis
rare condition with multiple adenomas | associated with glycogen storage disease
72
what is the histology of a hepatic adenoma
round, encapsulated, smooth normal hepatocytes - no portal tract, central veins or bile ducts solitary fat containing lesions
73
where are hepatic adenomas usually found
right lobe
74
who is most prone to hepatic adenomas
females | associated with the contraceptive pill
75
how does a hepatic adenoma appear on an US
filling defect
76
how does a hepatic adenoma appear on CT
diffuse enhancement
77
who is more prone to benign liver lesions
women
78
what is a simple liver cyst
liquid collection lined by epithelium | no biliary tree communication
79
what is a hyatid liver cyst
echinococcus granulosus (sheep parasite)
80
where are heated cysts most commonly seen
eastern europe central/south america middle east N. Africa
81
how is a hyatid cyst diagnosed
serology - Anti E granulosus ABs
82
how is a hyatid cyst treated
surgery albendazole percutaneous drainage
83
what is Polycystic liver disease
Embryonic ductal plate malformation of the intrahepatic biliary tree - numerous cysts throughout parenchyma
84
what are the 3 types of polycystic liver disease
VMC (von meyeberg complexes) PLD Autosomal dominant PLD
85
what is VMC polycystic liver disease
benign cystic nodules through liver | incidental finding
86
what are some s/s of PLD polycystic liver disease
symptoms depend on size of cyst abdominal pain distension
87
what is the difference in PLD and AD PLD
in PLD: liver function preserved, renal failure rare | AD PLD: renal failure, non-renal extra hepatic features, potential massive liver enlargement
88
what genes are altered in AD PLD
PKD1 and PKD2
89
what is the treatment of polycystic liver disease
transplant | defenestration/aspiration
90
``` high fever leukocytosis abdominal pain complex liver lesion what might you think of ```
liver abscess
91
what might someone with a liver abscess have a history of
abdominal / biliary infection | dental procedure
92
what are some treatments of liver abscess
BSABs aspiration/percutaneous drainage open drainage/resection
93
what are the two main types of malignant liver cancer
hepatocellular carcinoma | Fibro-Lamellar carcinoma
94
what is another less common malignant liver cancer
hepatoblastoma
95
what is the most common primary liver cancer
hepatocellular carcinoma
96
what are some things HCC is associated with
``` CIRRHOSIS Hep B Hep C alcohol aflatoxin ```
97
are men or women more prone to hepatocellular carcinoma
men
98
what are some s/s of HCC
``` weight loss RUQ pain mass obstruction acute liver failure asymptomatic liver bruit ```
99
what is a marker of HCC
alpha-feto protein
100
how is a HCC diagnosed
``` elevated AFP US triphasic CT MRI biopsy ```
101
what is the treatment of a HCC
``` transplant resection local ablation TACE - chemoembolisation sorafenib ```
102
how does HCC spread within the liver
nodular way
103
what are the two forms of HCC
hepatocytic or cholangio (resection)
104
who is more prone to getting fibro-lamellar carcinoma
young (3-35 year olds)
105
what is the main difference in hepatocellular carcinoma and fibro-lamellar carcinoma
fibro-lamellar is not related to cirrhosis
106
what is seen in the CT of a fibro-lamellar carcinoma
stellate scar with radial septa
107
what is the treatment of fibro-lamellar carcinoma
surgical resection transplant TACE for unresectable
108
are primary or secondary (metastatic) cancers more common in the liver
secondary - from colon, breast, lung, stomach, pancreas, melanoma
109
what is the most common cancer of the gall bladder
adenocarcinoma
110
what is adenocarcinoma of the gall bladder associated with
gallstones
111
what 2 diseases are adenocarcinomas of the bile ducts associated with
UC | PSC
112
what kind of jaundice does adenocarcinoma of the bile ducts show
obstructive jaundice
113
what is the most common form of bile duct cancer
adenocarcinoma
114
what is a cholangiocarcinoma a.k.a Klatskin tumour
malignant epithelial tumour - rare form of adenocarcinoma
115
how is an adenocarcinoma of the bile ducts diagnosed
duplex US spiral CT/ERCP/PTC MRI/MRCP/MRA
116
what is the only chance of cure of a gallbladder adenocarcinoma
surgical resection
117
"densely packed small glands in a fibrous stroma"
adenocarcinoma
118
what are the 2 types of cancer of the small bowel
lymphomas | carcinomas
119
what type of small bowel cancer is associated with IBD
carcinomas - looks like CRC
120
true/false | small bowel lymphomas are all non-hodgkins
true - start in white blood cells
121
what is small bowel lymphoma associated with
enteropathy-associated T and B cell lymphomas | coeliac
122
what is the treatment of small bowel lymphoma
surgery | chemo
123
what happens if a carcinoid tumour of the appendix locally invades the small intestine
intussusception | obstruction
124
where do mets of small bowel carcinomas go
liver
125
what secondary mets are common to the small bowel
ovary colon stomach
126
what is more common in small bowel cancer | primary or secondary
secondary
127
what is a polyp
protrusion above an epithelial surface
128
describe a pendunculated polyp
hangs off a stalk attached to walls of colon
129
describe a sessile polyp
flat
130
describe a serrated polyp
from villous
131
what is seen under the microscope of a polyp
dysplasia
132
what is a hyper plastic polyp
benign polyp with no malignant potential | hyperplasia of glands
133
what is an adenoma
benign epithelial tumour of glands (most common polyps in colon)
134
are adenomas premalignant
yes ---> adenocarcinoma
135
how do adenomas come about
via aden-carcinoma sequence - APC mutations ---> K-ras mutation ---> p53 mutation
136
what is the APC gene
tumour suppresor
137
how are polyps removed
endoscopy/surgery
138
what is FAP
familial adenomatous polyposis
139
what is the inheritance of FAP
autosomal dominant
140
what is mutated in FAP
APC gene
141
what is characteristic of FAP
100s of adenomatous colonic polyps | throughout colon
142
what is gardner syndrome
FAP + fibromatosis + osteomas
143
what is the prophylactic treatment of FAP
colon and rectum removed
144
are polyps symptomatic
usually asymptomatic but possible rectal bleeding
145
what is HNPCC (lynch)
hereditary non-polyposis CRC | gremlin mutation of DNA mismatch repair gene
146
what is more common FAP or HNPCC
HNPCC
147
what is the difference in onset of FAP and HNPCC
FAP - early onset | HNPCC - late onset
148
what is the inheritance of HNPCC
autosomal dominant
149
is there an inflammatory response to FAP
no
150
is there an inflammatory response to HNPCC
yes - Crohn's like inflammatory response
151
what is seen in HNPCC
<100 polyps | right sided mucinous tumour
152
what cancers as well as CRC is HNPCC associated with
gastric | endometrial carcinoma
153
what is the treatment of HNPCC
surgery | chemo/radio
154
if an adenocarcinoma is well differentiated what is the prognosis
good
155
if an adenocarcinoma is poorly differentiated what is the prognosis
bad
156
what is the treatment of adenocarcinoma of the colon
surgery - right hemicolectomy - left hemicolectomy - sigmoid colectomy radio - adjuvant/palliative for inoperable/recurrent rectal carcinoma chemo - fluorouracil, capecitabine - adjuvant for stage C stenting to prevent obstruction
157
what is the most common CRC
sigmoid tumours
158
what are some s/s of left sided CRC
``` PR blood/mucus mass altered bowel habit obstruction tenesmus ```
159
what are some s/s of right sided CRC
anaemia weight loss abdo pain
160
what are some general s/s of CRC
``` anaemia cachexia lymphadenopathy mass hepatomegaly distension blood ```
161
how is CRC diagnosed
colonoscopy + biopsy ba enema - apple core lesion CT colography
162
what can the CT scan be used for
stage spread
163
where do mets of CRC tend to go
liver lungs local structure lymphatics
164
what can be used for early detection of CRC
Faecal occult blood testing | + endoscopy to then remove if +ve
165
how is CRC staged
Dukes A - D and TNM
166
what is dukes A
confined to muscularis propria (muscularis mucosa) | HASNT INVADED MUSCLE WALL
167
what is dukes B
through muscularis propria | INVADED MUSCLE WALL
168
what is dukes C
metastatic to lymph nodes (+ muscle wall)
169
what is dukes D
distant mets
170
what is T1
submucosa | inner layer of bowel
171
what is T2
into muscle | into muscle layer
172
what is T3
through muscle | into outer lining
173
what is T4
adjacent structures | through the outer lining
174
what is NO
no lymph nodes
175
what is N1
< 3 nodes
176
what is N2
> 3 nodes
177
what is M0
no distant mets
178
what is M1
distant mets
179
how is lung/liver cancer staged
CT
180
how is rectal cancer staged
MRI
181
how can CRC spread
via adjacent structures lymphatic ally blood transcoelomic

year 1 (45 decks)

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