GI Cancers Flashcards by Anouk Wijeratne

What are cancers involving epithelial cells called?

Squamous Cell Carcinoma (SCC) Adenocarcinoma

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What are cancers involving neuroendocrine cells called?

Neuroendocrine Tumours (NETs)
Gastrointestinal Stromal Tumours (GISTs)

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Give example of neuroendocrine cells of the GI tract

Enterocendocrine cells

Interstitial cells of Cajal

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What are cancer involving connective tissues called?

Leiomyoma/leiomyosarcomas

Adipose tissue Liposarcomas

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What are the three parts of the oesophagus?

Cervical
Middle
Lower

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What are the two types of oesophageal cancer?

Squamous cell carcinoma

Adenocarcinoma

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What are the main features of squamous cell carcinoma?

From normal oesophageal squamous epithelium
Upper 2/3
Acetaldehyde pathway
Less developed world

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What are the main features of adenocarcinoma?

From metaplastic columnar epithelium
Lower 1/3 of oesophagus
Related to acid reflux
More developed world

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What leads to adenocarcinoma?

Oesophagitis (inflammation)
Barrett’s (metaplasia)
Adenocarcinoma (neoplasia)

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What is the guidelines for Barrett’s surveillance?

No dysplasia → Every 2-3 years
LGD → every 6 months
HGD → intervention

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What is LGD and HGD?

Low/High Grade dysplasia

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Who is most affected by oesophageal cancer?

Elderly males

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What are common facts about OG cancer?

Late presentation
65% palliative
High morbidity & complex surgery
Poor 5-year survival <20%
Palliation- difficult

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What are the diagnostic methods for OG cancer?

Endoscopy and biopsy

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What occurs after diagnosis of OG cancer?

Staging
CT Scan (chest, abdo and pelvis)
Laparoscopy (imaging with air, to look for smaller growths)
PET Scan?

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What are the treatment options for OG cancer?

Curative:
Neo-adjuvant chemo (pre-surgery)
Radical Surgery

Palliative:
Chemo
Stent

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How is a oesophagectomy performed?

Divide stomach
Divde oesophagus
Connect

Two-stage Ivor Lewis approach

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What are the main features for colorectal cancer?

Most common GI cancer in Western Societies
Third most common cancer death in men & women
Appendicitis is 8.6% M vs. 6.7% F

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What is the lifetime risk for colorectal cancer?

Lifetime risk
1 in 10 for men
1 in 14 for women

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Who is generally affected with colorectal cancer?

Generally affect patients > 50 years (>90% of cases)

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What are the different forms of colorectal cancer?

Sporadic
Familial (1st degree)
Hereditary syndrome

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What are the features of sporadic colorectal cancer?

Absence of family history, older population, isolated lesion

What are the features of familial colorectal cancer?

Family history, higher risk if index case is young (<50years) and the relative is close (1st degree

What are the features of hereditary colorectal cancer?

Family history, younger age of onset, specific gene defects

e.g. Familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal cancer (HNPCC or Lynch syndrome)

How do polyps form and become cancer?

Normal epithelium genetic mutation hyperprolifertive small polyp Series of other mutations Polyp becomes cancer over few years

What are the risk factors of colorectal cancer?

``` Past history Colorectal cancer Adenoma, ulcerative colitis, radiotherapy Family history 1st degree relative < 55 yrs Relatives with identified genetic predisposition (e.g. FAP, HNPCC, Peutz-Jegher’s syndrome) Diet/Environmental ?carcinogenic foods Smoking Obesity Socioeconomic status ```

What does clinical presentation depend upon?

Location ⅔ in descending colon and rectum ½ in sigmoid colon and rectum (i.e. within reach of flexible sigmoidoscopy)

How does caecal and right-sided cancer present?

``` Iron deficiency anaemia (most common) Change of bowel habit (diarrhoea) Distal ileum obstruction (late) Palpable mass (late) ```

How does left sided & sigmoid carcinoma present?

``` PR bleeding, mucus Thin stool (late) ```

How does rectal carcinoma present?

PR bleeding, mucus Tenesmus (urgency to defacate constantly) Anal, perineal, sacral pain (late)

What would you do when consulting a patient with suspected colorectal cancer?

Ask them about their bowel habits? | Examine abdomen for any palpable masses

How would local invasion in the pelvis present?

Bladder symtoms | Female genital tract symptoms

How might metastatic colorectal cancer present?

``` Liver (hepatic pain, jaundice) Lung (cough) Regional lymph nodes Peritoneum Sister Mary Joseph nodule (growth in umbilicus) Hepatomegaly (mets) Monophonic wheeze Bone pain ```

What are the signs of primary colorectal cancer?

Abdominal mass DRE: most <12cm dentate and reached by examining finger Rigid sigmoidoscopy Abdominal tenderness and distension – large bowel obstruction

What investigations could you do when diagnosing colorectal cancer?

Historically, barium enema | Colonoscopy now

Describe colonoscopy

Can visualize lesions < 5mm Small polyps can be removed Reduced cancer incidence Usually performed under sedation

Describe CT colonoscopy

``` Can visualize lesions > 5mm No need for sedation Less invasive, better tolerated If lesions identified patient needs colonoscopy for diagnosis Very detailed ```

What dictates which parts of the colon can be removeD?

Blood supply

Describe the epidemiology of pancreatic cancer

Commonest form of panc CA is pancreatic ductal adenocarcinoma (PDA) 80-85% have late presentation 15-20% have resectable disease

Why is pancreatic cancer so difficult to diagnose?

No unique diagnostic features

What are risk factors for pancreatic cancer?

``` Chronic pancreatitis Type II diabetes mellitus Cigarette smoking Family history Obesity >60 years ```

How does pancreatic cancer present clinically (head)?

Painless Jaundice (compression of CBD) Weight loss Pain (epigastrium radiated to back)

How does carcinoma of the body of tail and pancreas present?

Asymptomatic in early stages Weight loss Back pain Vomiting in late stages

What are the diagnostic methods for pancreatic cancer?

Tumor marker CA19-9 Ultrasonography Dual-phase CT ERCP/EUS biopsy - GOLD STANDARD

How do you treat pancreatic cancer surgically?

Whipples resection Join stomach to pancreas and bile duct + adjuvant chemo Beware of dumping syndrome and PUD

What is HCC

Hepatocellular carcinome

What are risk factors for HCC?

Cirrhosis | Hep B

What is the best way to treat HCC?

Liver transplant

What is the surgical treatment for Gastric cancer?

Roux-en-Y configuration surgery

What are the post-op complications of gastrectomies?

``` N+V Lack of appetite Early satiety Lack of nutrition Diarrhoea Dumping syndrome ```

What is important to remember in a GI exam?

Postero-lateral thoracotomy scars | Oesophagectomy

What are the presenting features of hepatocellular carcinoma?

``` FLAWS Hepatosplenomegaly Pruritus Jaundice Hepatic encephalopathy Deteriorating LFTs ```

What is a histological finding indicative of gastric adenocarcinoma?

Signer-ring cells