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ailmentary > GI cancer > Flashcards

GI cancer Flashcards

1
Q

cancers of the GI tract

A 
Splenic – less
Liver – frequent 
Small bowel tumour – less
Large – more 
parotid gland 
salivary gland 
oesophagus 
stomach 
pancreas
rectum 
anus
appendix
LI
duodenum 
gall bladder
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2
Q

why is cancer important

A

it is common - so is GI specifically
serious - causes a lot of deaths
it is what people are the most worried about

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3
Q

what is cancer

A

a disease caused by an uncontrolled division of abnormal cells in a part of the body

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4
Q

primary cancer

A

arising form cells in an organ directly

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5
Q

secondary/met

A

spread from another organ

direct invasion/metastasis

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6
Q

is GI cancer primary or secondary

A

bowel - primary

liver - secondary - blood supply

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7
Q

types of epithelial cells and their location

A

Squamous – oesophagus and rectum

Glandular epi – most of the way through

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8
Q

epithelial cancers

A

Squamous Cell Carcinoma

Adenocarcinoma

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9
Q

gastrinmtestinal tumours

A

benign

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10
Q

connective tissue and their canccers

A

Smooth muscle - Leiomyoma/leiomyosarcomas

Adipose tissue - Lipomas

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11
Q

neuroendocrine cells ands their tumours

A

Enterochromaffin cells - Carcinoid tumours

Interstitial cells of Cajal - Gastrointestinal Stromal Tumours

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12
Q

most common GI tumour

A

adenocarcinoma

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13
Q

what things do you need to ask someone who has dysphagia (difficulty swallowing)

A

Textures of what people can swallow
obstruction/failure in peristaltic mechanisms
Cancer – progressive, start with big bits and then to yoghurts whereas Neuromuscular – spontaneously cant do both
Vom – food cant even get down tubv
Weight loss – is worrying, not getting any food

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14
Q

what are risk factors for oesophageal cancer

A

previous reflux, overweight, smoking, alcohol

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15
Q

where is columnar epithelium in the oesophagus

A

near stomach

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16
Q

muscle through the oesophagus

A

progresses from skeletal to smooth

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17
Q

describe oesophageal cancer

A

From metaplastic columnar epithelium
Lower 1/3 of oesophagus
Related to acid reflux = recurrent damage to mucosa from acid
More developed world = obesity

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18
Q

why is being overweight a risk factor for acid reflux

A

increase abdominal pressure = force food back up

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19
Q

describe squamous cell carcinoma

A

From normal oesophageal squamous epithelium
Upper 2/3
Acetaldehyde pathway - increased by smoking and alcohol = damage epi
Less developed world - mutations in acetaldehyde dehydrogenase enzyme = build up of metabolite - increase risk of cancer

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20
Q

symptoms of acid reflux

A

Long history of heart burn, regurgitation and burping - stimulate oesophagus, swallow air - reflux = it comes back up

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21
Q

describe endoscopy

A

Pass tube down mouth – visually see oesophagus and stomach

Conscious

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22
Q

how does acid reflux progress to cancer

A 
chronic exposure to acid
injury, ongoing inflammation, cytokine drive 
15% pop have GORD
5-13% of them - Barrett's (metaplasia) 
5% per year - dysplasia 
0.5%-30% - carcinoma - neoplasia
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23
Q

barretts oesophagus

A

expression of cells where not normal eg columnar where expect to see squamous
metaplasia

24
Q

barretts oesophagus on endoscopy

A

Red- columnar

Black hole – gastroesophageal junction

25
Q

risk factors for colorectal cancer

A

Family History - has to be really strong, first degree relatives <50yrs

Specific inherited conditions
FAP (Familial adenomatous polyposis), HNPCC (hereditary nonpolyposis colorectal cancer), Lynch Syndrome

Uncontrolled Ulcerative Colitis

Age
Previous Polyps

26
Q

histology of adenocarcinoma

A

densification of tissue

27
Q

describe the progression to colorectal cancer

A
  1. inhibited by NSAIDSs, folate ca. caused by APC mutation -> hyperproliferative epithelium, abberent cryptic foci
  2. inhibited by NSAIDSs -> small adenoma
  3. inhibited by NSAIDSs and oestrogen, casued by K-ras nmutation -> large adenoma
  4. casued bt p53 mutation and loss of 18q -> colon cancer
28
Q

appearance of polyps as the progess

A

secile - on the epi lining
pedunculated
Necrotic area – black and white bits – definitely colorectal

29
Q

pathology of colorectal cancer

A

not single gene
sequence fo genetic errors - APC< K-ras, p52, 18q
affects the risk factors

30
Q

symptoms of colorectal cancers

A 
Asymptomatic (incidental anaemia) - routine blood test 
Change in Bowel Habit Diarrhoea more than constipation
Blood in Stool
Acute intestinal obstruction
weight loss 
loss of appetite 
nausea and vomiting 
rectal bleeding 
anaemia
31
Q

symptoms that are not associated with colorectal cancer

A

Rectal bleeding with anal symptoms - Itch, Soreness / discomfort, External lump, prolapse
constipation alone
abdominal pain with no obstruction

32
Q

use of x ray to diagnose colorectal cancer

A

Cant see the bowel
there is stifling appearance so proberly poo = constipation
+ cheap, easy, quick
- low sensitivity and specificity, No use to pick up early disease

33
Q

use of plane CT to diagnose colorectal cancer

A

+ Quick
Easy
See large lesions

  • May miss smaller lesions
    No tissue = No therapy
34
Q

process of barium enema

A

barium liquid is instilled in LI, patient move around, then viewed
Can do double – air next time – colon expand – see better

35
Q

barium enema for colorectal cancer

A

+ Reasonable Sensitivity and Specificity
- Time Intensive
Technically demanding
Unacceptable to patients

36
Q

process of colonoscopy

A

Pump it all the way round
recognise caecum by - appendix, ileoceacal valve, triradiate folds
Difficult to move rigid tube though a tube that moves
end of tube: video chip, irrigation channel, instrument channel - allow take samples, light

37
Q

colonoscopy for colorectal cancer

A 
\+ Safe
Relatively quick
High Sensitivity
Able to obtain tissue
- 2 days of iatrogenic diarrhoea
Small risk of perforation (<1:2000)
Risk of dehydration
38
Q

process of CT virtual colonoscopy

A

Give something similar to barium – drink
Put them in CT
“tag” stool using Bismuth
Technology to remove poo from bowel from the wall

39
Q

CT virtual colonoscopy for colorectal cancer

A

+Quick
Easy
Reduced Bowel prep more tolerable
As good as colonoscopy for lesions >6mm

  • unable to get tissue
    cant remove lesion
40
Q

way to remove bleed

A

Current to burn through bv – so that the vessel doesn’t bleed – pick up polyp and take away

Inject saline into wall – lift it away from wall – snair to remove it from the wall
Scar will heal after day/2

41
Q

problem with diagnosing pancreatic cancer

A

silent killer
non-specific
Virchow’s traid - pain, anorexia, weight loss - Not a massive proportion of patients `

42
Q

early symptoms of pancreatic cancer

A

Abdominal pain
Depression
Glucose intolerance - worry about the effect on the pancreas

43
Q

late symptoms of pancreatic

A

Weight loss
Jaundice
Ascites
Obstructed gall bladder

  • too late
44
Q

outcome of pancreatic cancer

A 
poor 
surgery curative on 20-25% cases 
1 year survival 18% 
5 year 2% 
only 20% suitable for resection
45
Q

describe the surgery for pancreatic cancer

A

take away panc, duodenum,, gall bladder - put everything else back after

46
Q

risk factors for pancreatic cancer

A 
Smoking
Drinking
Obesity
Family
Especially rare conditions such as MEN - Presents with cancer in family with different sites
47
Q

describe adenocarcinoma

A 
from metastatic columnar epi 
lowe 1/3 oesophagus 
acid reflux - repeated damage to oesophagus 
related to obesity 
developed world
48
Q

is adenocarcinoma more frequent in men or women

A

men

because of hormonal control in women

49
Q

list the phases in the progression of ADENOCARCINOMA

A

Normal epithelium

Hyperplasia - abnormal proliferation of epithelial cells

Development of adenomatous polyps

Development of adenocarcinoma

Metastasis

50
Q

list the phases in the progression of SQUAMOUS cell carcinoma

A

Normal epithelium

Metaplasia - development of abnormal squamous cell

Dysplasia - proliferation of abnormal cells

Severe dysplasia - almost all cells are abnormal

Development of squamous cell carcinoma

Metastitsis

51
Q

symptoms of oesophageal cancer

A

when >50% circumference of oesophagus is cancerous - narrowing of the tube
- Difficulty and pain when swallowing
Weight loss - due to lack of nutrition
Pain in the breast bone and stomach, or a feeling of reflux

later symptoms: Nausea, vomiting, and regurgitation of food
Vomiting blood, due to trauma to the tumour

52
Q

what does a CT check for

A

metastasis

53
Q

treatment of oesophageal cancer

A

surgery - tumour removed from oesophageal wall
oesophagectomy - remobval of part of the oesophagus

chemo and radiotherapy

54
Q

cause of colorectal cancer

A

diet
alcohol
tobacco
lack of physical activity

55
Q

treatment of colorectal cancer

A

surgery - removal of tumour via colonscopy or laparotomy
may result in removal of large parts of colon = colonstomy

chemo and radiotherapy

ailmentary (15 decks)

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