GI cancer JH Flashcards
what are the possible upper GI cancers?
– Oesophageal
– Stomach
– Liver (notcovered)
– Pancreas
– Gallbladder(notcovered)
– Smallintestine(not covered)
what are the possible lower GI cancers?
– Colorectal
– Anus(notcovered)
where can gastric cancer start in?
- Gastric mucosa (adenocarcinoma)
- Connective tissueofthegastric wall(gastrointestinalstromal tumours(GIST))
- Neuroendocrine tissue (carcinoid)
- lymphoid tissues- lymphomas
how is h.pylori diagnosed/treated?
Can cause inflammation, potentially leading to
stomach ulcers or cancer
* Diagnosis through blood, breath or stool test
* Treat with 7-day triple therapy: two antibiotics
and a PPI BD
what are alarm symptoms?
- Dysphagia
- Weightloss(unintentional)
- Epigastricmass
- Recentonsetdyspepsiaif>55yrs
- Persistentvomiting
- Irondeficiencyanaemia
when would you use surgical management?
- Surgery(only curative treatment)
- Endoscopic mucosal resection
- Early stage cancer
- Total or subtotal gastrectomy
- Major surgery
- adjuvant chemo
what are the different combination chemo options?
- epirubicin, oxaliplatin and capecitabine (EOX)
- epirubicin, oxaliplatin and fluorouracil (EOF)
- fluorouracil,oxaliplatin,docetaxel (FLOT)
when is radiotherapy used?
- Rarely used in early stage cancer
- Palliatesymptoms
- Shrink tumour if causing obstruction
- reduce gastric bleeding
what are the two types of oseophageal cancer?
- Squamous cells (squamous cell carcinoma)
- glandular cells
how do you surgically manage oesophageal cancer?
- Surgery
– MainstayofcurativeTx - Oesophagectomy
- Full
- Partial
- Stenting
– Symptom control of advanced
disease
when to use chemo in oesophageal cancer?
– Inoperable local disease
– Unfit for surgery
– Can cure some early stage cancers
– Can also be used before surgery
what is pancreatic cancer?
Pancreas is a large gland
* Makes digestive enzymes and insulin
* Normally adenocarcinomas
what are the sympoms of pancreatic cancer?
pain in back or stomach, weight loss, jaundice
how is pancreatic cancer surgically managed?
- Surgery-10% of patients
– Pancreatectomy - Whipple’s procedure removes head of pancreas,
duodenum, gall bladder - Distal removes body and tail
- Total removes whole pancreas and associated structures
–rarely used
what happens if its borderline resectable?
- Tumour growth very close to blood vessels
- Chemoradiotherapy can be used to shrink
tumour enough for surgery
how does colon cancer present?
Dependingonthestageofpresentationpatientsmaypresent
– Anorexia
– Anaemia
– Changeofbowelhabit
* Passingofmucous
* Diarrhoea alternatingwithconstipation
* Bloodinstool
– Rectalbleeding
– Abdominalpain
– Intestinalobstruction
– Palpablemassinabdomen
how do you treat colon cancers?
Treatmentisacombinationof
–Surgery
–Radiotherapy
–Chemotherapy
* This is dependant upon the site and stage of the
disease
* Surgery is nearly always the initial choice of
treatment
what is a stoma?
Following colorectal surgery, many patients will
require permanent or temporary colostomy
* Specialist stoma nurse will provide support to
patients
what is the adjuvant treatment for dukes b/c?
WEEKLY5-FLUOROURACILANDFOLINICACID
what is the adjuvant treatment for dukes c- T1-3 n1 , t4 ir N2?
- FOLFOX (Oxaliplatin+5FU)
- CAPOX(XELOX)Capecitabine&Oxaliplatin)
- capecitabine
what is the chemo used for advanced diseases?
- FOLFIRI(Irinotecan+5FU)
- CAPIRI(XELIRI)Irinotecan& Capecitabine
what is DPD?
- Dihydropyrimidine dehydrogenase
– Enzyme that helps process thymine and uracil. DPD also breaks down the drugs fluorouracil and capecitabine.
what happens if a patient has a DPD deficiency?
means the patient is more likely to have severe side effects from these chemo drugs as they build up in the body
what are some of the side effects that can occur from DPD deficiency?
– Neutropenia, anaemia, thrombocytopenia
– Diarrhoea( moreseverethanusuallyexpected)
– Mucositis
– N &V(moreseverethanusuallyexpected)
does a lack of DPD cause symptoms?
no
what is thesurgery treatment for metastatic disease?
surgery- pallative/ resection of liver or lung metastases/ resection considered for single metastases to other organs
what is the chemo used for metastatic disease?
- FOLFOX/FOLFIRI+
Cetuximab(inoperable liver mets)-1st line
treatment of metastatic colorectal cancer - Or Panitumumab +FOLFIRI/FOLFOX Continuous Infusion of 5
fluorouracil - first line chemotherapyR egimes (XELOX/FOLFOX)