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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
Q

what are 2 types of benign gastric lesions

A

hyperplastic polyp

cystic fundic gland polyps

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26
Q

what is a more common gastric carcinoma - intestinal or diffuse type
which has better prognosis

A

intestinal

intestinal

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27
Q

what are some risk factors for oral cancer

A 
tobacco
alcohol
age
men > women
HPV - oropharyngeal cancer 
Vitamin A and C deficiency
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28
Q

where do adenocarcinomas of the stomach most commonly occur

A

proximally - GO junction, cardia

linked to H. Pylori

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29
Q

what are some s/s of gastric cancer

A 
weightless
abdominal pain
anaemia
early satiety 
jaundice
abdominal mass
loss of blood
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30
Q

what type of gastric cancer is “large, irregular ulcer at lesser curvature”

A

intestinal carcinoma

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31
Q

what are some risk factors for intestinal type carcinoma

A

H. Pylori
Autoimmune Gastritis
nitrosamines in smoked foods
Blood type A

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32
Q

how does chronic gastritis cause intestinal type carcinoma

A

chronic gastritis —> intestinal metaplasia/atrophy –> dysplasia —> carcinoma

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33
Q

what type of cancer is “signet ring cells” and “desmoplasia with thickening in stomach wall”

A

diffuse type

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34
Q

is Diffuse type carcinoma associated with H. Pylori, intestinal metaplasia or nitrosamines?

A

no

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35
Q

what are 3 investigations done for gastric cancer

A

gastroscopy + biopsy
Ba swallow
CT scan

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36
Q

what is the typical surgical treatment of proximal lesions in gastric cancer

A

total gastrectomy

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37
Q

what is the typical surgical treatment of distal lesions in gastric cancer

A

partial gastrectomy

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38
Q

in gastric carcinomas is treatment curative

A

no, palliative

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39
Q

what can be seen if gastric cancer spreads to lymph nodes

A

Virchow’s node - left supraclavicular node

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40
Q

where are distant mets most common to

A

liver

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41
Q

is pernicious anaemia pre malignant

A

yes

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42
Q

what are some other types of malignant gastric cancers

A

lymphomas, GIST, Maltoma

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43
Q

what does GIST stand for

A

Gastrointestinal stromal tumour
may be benign or malignant and are most commonly in STOMACH and small intestine
linked to ICC
mesenchymal tumour

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44
Q

what does MALT stand for

A

Mucosa associated lymphoid tissue - derived
accoc. H Pylori
involve B cells

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45
Q

what is the most common cancer of the appendix

A

carcinoid tumour - causes intussusception and obstruction

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46
Q

where does a carcinoid tumour arise from

A

crypts of lieberkuhn

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47
Q

what does a carcinoid tumour look like

A

brown-yellow nodule

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48
Q

what is the treatment for an appendix tip tumour

A

appendicectomy

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49
Q

what is the treatment for an appendix base tumour

A

right helicolectomy

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50
Q

what is carcinoid syndrome

A 
liver metastases of appendix carcinoid tumour
release serotonin (5HT) - paraneoplastic
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51
Q

what are some s/s or carcinoid syndrome

A

facial flushing
diarrhoea
bronchospasm
hypotension

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52
Q

what is an investigation for carcinoid syndrome

A

urinary 5-HIAA

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53
Q

what are some s/s of pancreatic cancer

A 
jaundice (dark urine, light stools)
weight loss
anorexia
nausea and vomitng
back pain
abdominal pain
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54
Q

what are some risk factors of pancreatic cancer

A 
smoking
charred meat
obesity
physical inactivity 
diabetes
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55
Q

what is the investigation for pancreatic cancer

A

CT

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56
Q

what staging is used for pancreatic cancer

A

TNM

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57
Q

what treatment is used if a pancreatic cancer is resectable

A

whipple resection or total/distal pancreatectomy

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58
Q

what treatment is used if a pancreatic cancer isn’t resectable

A

biliary/gastric bypass

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59
Q

what is the most common type of exocrine cancer

A

adenocarcinoma - can’t be resected
located in head body or tail
causes bile duct obstruction

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60
Q

what are 3 types of endocrine cancers

A

gastrinoma - release gastrin - increased stomach acid - gastric/duodenal ulcers
insulinoma - release insulin - body stores sugar - hypoglycaemia
glucagonoma - release glucagon - hyperglycaemia

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61
Q

if a solid malignant lesion is found in an older patient’s liver is it more likely to be primary or secondary

A

secondary

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62
Q

is a solid lesion in a cirrhotic liver more likely to be primary or secondary

A

primary

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63
Q

what are 3 benign liver lesions

A

hemangioma
Focal nodular hyperplasia
Hepatic Adenoma

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64
Q

what is the most common liver tumour

A

hemangioma

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65
Q

are men or women more prone to hemangioma

A

women

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66
Q

how do you describe a hemangioma

A

hypervascular

single, small, well demarcated capsule

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67
Q

what does a hemangioma look like on US

A

well demarcated echogenic spot

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68
Q

who is most prone to focal nodular hyperplasia

A

young middle aged women

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69
Q

what is the histology of a focal nodular hyperplasia

A

central scar containing large artery with radiating branches (hub and spoke)
sinusoids, bile ducts and kupffer cells all present

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70
Q

what is a focal nodular hyperplasia

A

hyper plastic response to abnormal blood flow e.g. congenital vascular abnormality

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71
Q

what is adenomatosis

A

rare condition with multiple adenomas

associated with glycogen storage disease

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72
Q

what is the histology of a hepatic adenoma

A

round, encapsulated, smooth
normal hepatocytes - no portal tract, central veins or bile ducts
solitary fat containing lesions

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73
Q

where are hepatic adenomas usually found

A

right lobe

74
Q

who is most prone to hepatic adenomas

A

females

associated with the contraceptive pill

75
Q

how does a hepatic adenoma appear on an US

A

filling defect

76
Q

how does a hepatic adenoma appear on CT

A

diffuse enhancement

77
Q

who is more prone to benign liver lesions

78
Q

what is a simple liver cyst

A

liquid collection lined by epithelium

no biliary tree communication

79
Q

what is a hyatid liver cyst

A

echinococcus granulosus (sheep parasite)

80
Q

where are heated cysts most commonly seen

A

eastern europe
central/south america
middle east
N. Africa

81
Q

how is a hyatid cyst diagnosed

A

serology - Anti E granulosus ABs

82
Q

how is a hyatid cyst treated

A

surgery
albendazole
percutaneous drainage

83
Q

what is Polycystic liver disease

A

Embryonic ductal plate malformation of the intrahepatic biliary tree - numerous cysts throughout parenchyma

84
Q

what are the 3 types of polycystic liver disease

A

VMC (von meyeberg complexes)
PLD
Autosomal dominant PLD

85
Q

what is VMC polycystic liver disease

A

benign cystic nodules through liver

incidental finding

86
Q

what are some s/s of PLD polycystic liver disease

A

symptoms depend on size of cyst
abdominal pain
distension

87
Q

what is the difference in PLD and AD PLD

A

in PLD: liver function preserved, renal failure rare

AD PLD: renal failure, non-renal extra hepatic features, potential massive liver enlargement

88
Q

what genes are altered in AD PLD

A

PKD1 and PKD2

89
Q

what is the treatment of polycystic liver disease

A

transplant

defenestration/aspiration

90
Q 
high fever
leukocytosis
abdominal pain
complex liver lesion
what might you think of
A

liver abscess

91
Q

what might someone with a liver abscess have a history of

A

abdominal / biliary infection

dental procedure

92
Q

what are some treatments of liver abscess

A

BSABs
aspiration/percutaneous drainage
open drainage/resection

93
Q

what are the two main types of malignant liver cancer

A

hepatocellular carcinoma

Fibro-Lamellar carcinoma

94
Q

what is another less common malignant liver cancer

A

hepatoblastoma

95
Q

what is the most common primary liver cancer

A

hepatocellular carcinoma

96
Q

what are some things HCC is associated with

A 
CIRRHOSIS
Hep B
Hep C
alcohol 
aflatoxin
97
Q

are men or women more prone to hepatocellular carcinoma

98
Q

what are some s/s of HCC

A 
weight loss
RUQ pain
mass
obstruction
acute liver failure
asymptomatic
liver bruit
99
Q

what is a marker of HCC

A

alpha-feto protein

100
Q

how is a HCC diagnosed

A 
elevated AFP
US
triphasic CT
MRI
biopsy
101
Q

what is the treatment of a HCC

A 
transplant
resection
local ablation
TACE - chemoembolisation
sorafenib
102
Q

how does HCC spread within the liver

A

nodular way

103
Q

what are the two forms of HCC

A

hepatocytic or cholangio (resection)

104
Q

who is more prone to getting fibro-lamellar carcinoma

A

young (3-35 year olds)

105
Q

what is the main difference in hepatocellular carcinoma and fibro-lamellar carcinoma

A

fibro-lamellar is not related to cirrhosis

106
Q

what is seen in the CT of a fibro-lamellar carcinoma

A

stellate scar with radial septa

107
Q

what is the treatment of fibro-lamellar carcinoma

A

surgical resection
transplant
TACE for unresectable

108
Q

are primary or secondary (metastatic) cancers more common in the liver

A

secondary - from colon, breast, lung, stomach, pancreas, melanoma

109
Q

what is the most common cancer of the gall bladder

A

adenocarcinoma

110
Q

what is adenocarcinoma of the gall bladder associated with

A

gallstones

111
Q

what 2 diseases are adenocarcinomas of the bile ducts associated with

112
Q

what kind of jaundice does adenocarcinoma of the bile ducts show

A

obstructive jaundice

113
Q

what is the most common form of bile duct cancer

A

adenocarcinoma

114
Q

what is a cholangiocarcinoma a.k.a Klatskin tumour

A

malignant epithelial tumour - rare form of adenocarcinoma

115
Q

how is an adenocarcinoma of the bile ducts diagnosed

A

duplex US
spiral CT/ERCP/PTC
MRI/MRCP/MRA

116
Q

what is the only chance of cure of a gallbladder adenocarcinoma

A

surgical resection

117
Q

“densely packed small glands in a fibrous stroma”

A

adenocarcinoma

118
Q

what are the 2 types of cancer of the small bowel

A

lymphomas

carcinomas

119
Q

what type of small bowel cancer is associated with IBD

A

carcinomas - looks like CRC

120
Q

true/false

small bowel lymphomas are all non-hodgkins

A

true - start in white blood cells

121
Q

what is small bowel lymphoma associated with

A

enteropathy-associated T and B cell lymphomas

coeliac

122
Q

what is the treatment of small bowel lymphoma

A

surgery

chemo

123
Q

what happens if a carcinoid tumour of the appendix locally invades the small intestine

A

intussusception

obstruction

124
Q

where do mets of small bowel carcinomas go

125
Q

what secondary mets are common to the small bowel

A

ovary
colon
stomach

126
Q

what is more common in small bowel cancer

primary or secondary

127
Q

what is a polyp

A

protrusion above an epithelial surface

128
Q

describe a pendunculated polyp

A

hangs off a stalk attached to walls of colon

129
Q

describe a sessile polyp

130
Q

describe a serrated polyp

A

from villous

131
Q

what is seen under the microscope of a polyp

132
Q

what is a hyper plastic polyp

A

benign polyp with no malignant potential

hyperplasia of glands

133
Q

what is an adenoma

A

benign epithelial tumour of glands (most common polyps in colon)

134
Q

are adenomas premalignant

A

yes —> adenocarcinoma

135
Q

how do adenomas come about

A

via aden-carcinoma sequence - APC mutations —> K-ras mutation —> p53 mutation

136
Q

what is the APC gene

A

tumour suppresor

137
Q

how are polyps removed

A

endoscopy/surgery

138
Q

what is FAP

A

familial adenomatous polyposis

139
Q

what is the inheritance of FAP

A

autosomal dominant

140
Q

what is mutated in FAP

141
Q

what is characteristic of FAP

A

100s of adenomatous colonic polyps

throughout colon

142
Q

what is gardner syndrome

A

FAP + fibromatosis + osteomas

143
Q

what is the prophylactic treatment of FAP

A

colon and rectum removed

144
Q

are polyps symptomatic

A

usually asymptomatic but possible rectal bleeding

145
Q

what is HNPCC (lynch)

A

hereditary non-polyposis CRC

gremlin mutation of DNA mismatch repair gene

146
Q

what is more common FAP or HNPCC

147
Q

what is the difference in onset of FAP and HNPCC

A

FAP - early onset

HNPCC - late onset

148
Q

what is the inheritance of HNPCC

A

autosomal dominant

149
Q

is there an inflammatory response to FAP

150
Q

is there an inflammatory response to HNPCC

A

yes - Crohn’s like inflammatory response

151
Q

what is seen in HNPCC

A

<100 polyps

right sided mucinous tumour

152
Q

what cancers as well as CRC is HNPCC associated with

A

gastric

endometrial carcinoma

153
Q

what is the treatment of HNPCC

A

surgery

chemo/radio

154
Q

if an adenocarcinoma is well differentiated what is the prognosis

155
Q

if an adenocarcinoma is poorly differentiated what is the prognosis

156
Q

what is the treatment of adenocarcinoma of the colon

A

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
Q

what is the most common CRC

A

sigmoid tumours

158
Q

what are some s/s of left sided CRC

A 
PR blood/mucus
mass
altered bowel habit
obstruction
tenesmus
159
Q

what are some s/s of right sided CRC

A

anaemia
weight loss
abdo pain

160
Q

what are some general s/s of CRC

A 
anaemia
cachexia
lymphadenopathy
mass
hepatomegaly
distension
blood
161
Q

how is CRC diagnosed

A

colonoscopy + biopsy
ba enema - apple core lesion
CT colography

162
Q

what can the CT scan be used for

A

stage spread

163
Q

where do mets of CRC tend to go

A

liver
lungs
local structure
lymphatics

164
Q

what can be used for early detection of CRC

A

Faecal occult blood testing

+ endoscopy to then remove if +ve

165
Q

how is CRC staged

A

Dukes A - D and TNM

166
Q

what is dukes A

A

confined to muscularis propria (muscularis mucosa)

HASNT INVADED MUSCLE WALL

167
Q

what is dukes B

A

through muscularis propria

INVADED MUSCLE WALL

168
Q

what is dukes C

A

metastatic to lymph nodes (+ muscle wall)

169
Q

what is dukes D

A

distant mets

170
Q

what is T1

A

submucosa

inner layer of bowel

171
Q

what is T2

A

into muscle

into muscle layer

172
Q

what is T3

A

through muscle

into outer lining

173
Q

what is T4

A

adjacent structures

through the outer lining

174
Q

what is NO

A

no lymph nodes

175
Q

what is N1

176
Q

what is N2

177
Q

what is M0

A

no distant mets

178
Q

what is M1

A

distant mets

179
Q

how is lung/liver cancer staged

180
Q

how is rectal cancer staged

181
Q

how can CRC spread

A

via adjacent structures
lymphatic ally
blood
transcoelomic

year 1 (45 decks)

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