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Gastro > GI Cancer > Flashcards

GI Cancer Flashcards

1
Q

Staging used + the levels of colorectal cancer

A

Duke’s staging used or TNM

Duke A = invasion into but not through bowel wall

Duke B = invasion through bowel but not nodes

Duke C = lymph nodes involved

Duke D = distant mets

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2
Q

Types of colorectal cancer + how best to manage each

A

SCC = anal + rectal (chemoradiotherapy)

Adenocarcinomas (mucinois or signet ring) further up (surgery)

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3
Q

When should you refer a pt with bowel symptoms?

A

Aged >40, rectal bleeding + change in bowel habit >6wks

Aged >60, rectal bleeding OR change in bowel habit

Any pt with RIF mass or rectal mass Iron deficiency anaemia

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4
Q

Epidemiology of colorectal cancer

A

4th most common cancer

Colon 1.5x more common than rectal

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5
Q

RF for colorectal cancer

A

Caucasian

Low SES

Increasing age

FH colorectal neoplasia/ carcinoma

IBD-UC, Obesity

Diet high in animal fat, poor in fibre

Polyposis syndromes (HNPCC, FAP, Gardner’s syndrome)

Gene mutations in APC gene

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6
Q

Symptoms of R colon cancer

A

Weight loss, anaemia, occult bleeding, mass in RIF, disease likely advanced

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7
Q

Symptoms of L colon cancer

A

Colicky pain, rectal bleeding, bowel obstruction, tenesmus, mass in LIF, early change in bowel habit

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8
Q

Symptoms of rectal tumours

A

Anaemia, occult bleeding, masses felt

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9
Q

Common mets for colorectal cancer

A

Bladder, ureters, small bowel + stomach, uterus/ vagina/ prostate

Lymphatics (mesenteric/ groin/ supraclavicular)

Blood - to lungs + liver

Transcoelemic - peritoneal seedlings

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10
Q

Investigations for colorectal cancer

A

Straight to colonscopy/ flexible sigmoidoscpy if red flag symptoms OR Seen by colorectal surgeon within 14 days

CT colonography - good for staging + identifying polyps

Measure CEA

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11
Q

Screening - what is offered + at what age for colorectal cancer

A

Flexi sig at 55 y/o

FOBT - between 60-74 y/o every 2 years

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12
Q

How is the diagnosis made for colorectal cancer?

A

Colonscopy with biopsy = gold standard

Flex sig if comorbidities

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13
Q

5 year survival by Dukes stage

A

A = 80%

B = 50%

C = 15-40%

D = 5%

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14
Q

Management + time frame to start treatment for colorectal cancer

A

Must start in 62 days

Surgery +- adjuvant chemo

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15
Q

Rectal cancer treatment

A

Anterior resection/ APER/ Hartmans

Neoadjuvant radiotherapy = then remove mesorectum

High risk = chemoradiation then surgery

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16
Q

SCC anal cancer treatment

A

5 weeks chemoradiotherapy

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17
Q

What is a TME?

A

Total mesorectal excision = complete removal of mesorectum

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18
Q

What is an AP resection?

A

Abdomino-perineal resection = for cancer in lower rectum/ anus.

Permanent colostomy

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19
Q

Complications of bowel cancer

A

Obstruction, perforation, surgical risks

Short bowel syndrome

Mets

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20
Q

Follow up after bowel cancer surgery

A

CT scan at 18 months, 3 and 5 years

Colonscopy within 12 months + 3 years after

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21
Q

When is chemo used?

A

Adjuvant chemo for Dukes C

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22
Q

Types of oesophageal cancer

A

Mostly epithelial, SCC or AC

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23
Q

RF for oesophageal cancer

A

AC = caucasian males

SCC = smokers + alcohol drinkers

>60 y/o

Males

Barrett’s oesophagus

Tylosis (hyperkeratosis) + Patterson-Brown-Kelly syndrome

Obesity, FH of hiatus hernia

24
Q

Red flag symptoms for oesophageal cancer

A

Dysphagia Vomiting Weight loss Retrosternal pain Hiccups Hoarseness

25
Q

Signs of oesophageal cancer

A

Odynophagia Malaena Lymphadenopathy

26
Q

Investigations for oesophageal cancer

A

Urgent endoscopy with biopsy

EUS for local spread

CXR + CT for mets

FDG-PET for mets - more accurate

Double contrast barium swallow

27
Q

Management of oesophageal cancer

A

Surgery alone (endoscopic mucosal resection = early, oesophagectomy = late) +- chemo + radiotherapy (neo-adjuvant)

Squamous cell cancer = chemoradiotherapy +/- surgery

28
Q

Types + locations of gastric cancer

A

50% involve pylorus, 25% lesser curve + 10% cardia

2-8% are lymphomas (MALT)

Adenocarcinomas most common

29
Q

RF for gastric cancer

A

M:F 8:1

Low SES

H pylori

High salt foods Low fruit + veg

Smoking

Gastritis, pernicious anaemia

FH Blood group A

30
Q

Red flag symptoms for gastric cancer

A

Advanced = dyspepsia, weight loss, vomiting, dysphagia, anaemia

Early = uncomplicated dyspepsia

31
Q

Incurable signs of gastric cancer

A

Epigastric mass, hepatomegaly, jaundice, ascites,

Troisier’s sign (enlarged L supraclavicular node (Virchow’s node)), acanthosis nigricans

32
Q

Investigations for gastric cancer

A

Flexible endoscopy + biopsies

FDG-PET-CT for staging, EUS for assessing tumor depth + lymph node involvement

Consider staging laparoscopy (if potentially curable)

HER2 testing for metastatic oesophago-gastric adenocarcinoma

33
Q

Management of gastric cancer

A

Surgery + neo-adjuvant + adjuvant chemo/ chemoradiotherapy

Distal tumours = subtotal gastrectomy

Proximal = total gastrectomy

Offer nutritional support for pts having radical treatment (enteral or parenteral)

Palliative chemo (trastuzumab for pts with HER2+ adenocarcinoma)

34
Q

Types of pancreatic cancer

A

Endocrine = pancreatic neuroendocrine tumours (PNETs) = 5%

Exocrine = 90% infiltrating-ductal carcinomas

35
Q

RF for PNETs

A

MEN1 mutation

Von Hippel-Lindau

Neurofibromatosis type 1

Female

36
Q

RF for exocrine pancreatic cancer

A

Smoking Diet (high BMI, high red meat, low fruit +veg)

Pancreatitis

FH

Familial cancer syndromes = BRCA, Peutz-Jeghers syndrome, Lynch syndrome

37
Q

Red flag symptoms for PNETs

A

Insulinoma = hypoglycaemia

Gastrinoma = zollinger-ellison (severe peptic ulceration + diarrhoea)

Glucogonama = diabetes symptoms

38
Q

Red flag symptoms for exocrine pancreatic tumours

A

Painless, progressive, obstructive jaundice, steatorrhea (if in head)

Non specific symptoms if in body or tail: abdo pain, obstructive jaundice, acute pancreatitis, weight loss, steatorrhoea, N+V

39
Q

What is courvoisier’s sign?

A

Palpable gallbladder in the presence of painless jaundice

40
Q

Management of PNETs

A

Surgery if resectable

Chemo, ablation, chemoembolisation, biotherapy

41
Q

Management of exocrine pancreatic tumours

A

Surgical resection = only 10-20% suitable

Use Whipple’s

Chemo + stenting + RT

Chemo for metastatic pancreatic cancer

42
Q

When to refer a pt with suspected pancreatic cancer?

A

Aged over 40 + jaundice

Non-urgent CT = >60 with weight loss + diarrhea, back pain, abdo pain, N+V, constipations or new-onset diabetes

43
Q

How does oesophageal cancer appear on endoscopy (early v late)?

A

Early = superficial plaques, nodules, ulcerations

Advanced = strictures, ulcerated masses or large ulcerations

44
Q

When to refer a pt for endoscopy if ?oesophageal cancer?

A

Dysphagia or >55 with weight loss + upper abdo pain, reflux or dyspepsia

Non urgent endoscopy for people with haematemesis

45
Q

When to refer a pt with ?stomach cancer?

A

Upper abdo mass

Dysphagia

>55 with weight loss + upper abdo pain, reflux or dyspepsia

Endoscopy

Non-urgent = haematemesis

46
Q

When to refer someone with ?gallbladder cancer?

A

US with pts with upper abdo mass consistent with enlarged gallbladder

47
Q

When to refer people with ?liver cancer?

A

US for people with enlarged liver

48
Q

Investigations for pancreatic cancer

A

US is highly sensitive for biliary tract dilation + pancreatic masses >3cm

ERCP - therapeutic not diagnostic

MRCP

CT for pts without jaundice (when pancreatitis is a differential)

EUS if jaundiced, upper abdo pain + weight loss, if there is no lesion of US or CT

49
Q

Staging for pancreatic cancer

A

When mass is found on CT or US, triple phase helical CT used to assess mets

Resectable vs unresectable

Unresectable if: extensive lymphatic involvement, distant mets, direct involvement of superior mesenteric artery, inferior vena cava, aorta, celiac axis or hepatic artery

CA19.9 to assist in prognosis

EUS-guided FNA for biopsy in unresectable or neo-adjuvant Tx

50
Q

Link to germline mutations in pancreatic cancer

A

4-20% of pancreatic cancer have germline mutations in cancer predisposition genes

51
Q

What are the common liver lesions?

A
  • Hepatic hemangioma
  • Focal nodular hyperplasia
  • Hepatic adenoma
  • Idiopathic noncirrhotic portal hypertension (including nodular regenerative hyperplasia)
  • Regenerative nodules
  • Hepatocellular carcinoma
  • Cholangiocarcinoma
  • Metastatic disease
52
Q

S+S of liver tumors

A

Asymptomatic

Pain/ palpable mass

Complications such as variceal hemorrhage or ascites

Paraneoplastic syndrome

53
Q

What paraneoplastic syndrome occurs with liver cancer?

A

Hypoglycaemia, erythrocytosis, hypercalcaemia, severe diarrhea

54
Q

What is LI-RADS?

A

Estimates likelihood of HCC + malignancy + classifies lesions

55
Q

Management of HCC

A

Surgical resection but most aren’t eligible

Liver transplant

Thermal ablation or radiation if unsuitable for surgery

56
Q

4 categories of anal cancer

A

Tumours developing from lining mucosa (glandular, transitional + squamous)

Tumours on hair bearing skin (anal margin cancer)

Adenocarcinoma arising from glandular sections (rare)

Primary rectal SCC (v rare)

57
Q

Management of adenocarcinoma of anal canal

A

Surgery

Gastro (11 decks)

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