GI Cancers Flashcards
what is cancer
disease caused by an uncontrolled division of abnormal cells in a part of the body
what is primary cancer
Arising directly from the cells in an organ
what is secondary cancer or metastasis
Spread to another organ, directly or by other means (blood or lymph)
what is squamous cell carcinoma
from normal oesophageal squamous epithelium
Upper 2/3 (where stratified squamous epithelium is)
Alcohol metabolised = acetaldehyde is v toxic + carcinogen (more common in less developed world)
what is adenocarcinoma
from metaplastic columnar epithelium
lower 1/3 of oesophagus
related to acid reflux (more common in developed world)
what is the progression from reflux to cancer
oesophagitis (inflammation) to Barrett’s (metaplasia) to adenocarcinoma (neoplasia)
How does Barrett’s go to cancer
Barrett’s metaplasia to low grade dysplasia to high grade dysplasia
oesophageal cancer epidemiology
affects the elderly
more common in men (10:1)
9th most common cancer
Is there high survival from oesophageal cancer?
presents late dysphagia + weight loss high morbidity poor 5 yr survival <20% mostly palliative
what is the treatment plan for oesophageal cancer
Stage the cancer
CT/ laparoscopy
OGD if suspicious there is a tumour there
neo-adjuvant chemo for all adenocarcinomas + radical surgery
what is colorectal cancer
most common GI cancer in western societies
generally >50
third most common cancer cause of death in men + women
Forms of colorectal cancer
sporadic
familial
hereditary syndrome
Forms of colorectal cancer
sporadic
familial
hereditary syndrome
sporadic form of colorectal cancer
absence of family history
older pop
isolated lesion
familial form of colorectal cancer
family history
higher risk index if young
relative is close (1st degree)
hereditary form of colorectal cancer
family history
younger age of onset
specific gene defects
how does colorectal cancer progress (mechanism)
APC mutation -> COX-2 overexpression (hyperproliferative epithelium) -> K-ras mutation -> p53 mutation -> colon carcinoma
risk factors of colorectal cancer
past history - ulcerative colitis/ colorectal cancer etc
family history - 1st degree relative
diet/ environmental - smoking/ obesity/ SES
clinical presentation of colorectal cancer
2/3 in descending colon + rectum
1/2 in sigmoid colon + rectum
symptoms of colorectal cancer
iron deficiency anaemia (MOST COMMON) - tumours bleeding
Left side/ sigmoid - noticeable bleeding + mucus
Rectal carcinoma - tenesmus/ bleeding + mucus
change of bowel habit - diarrhoea
distal ileum obstruction
palpable mass
Late local invasion symptoms of colorectal cancer
bladder symptoms
female genital tract symptoms
metastastic symptoms of colorectal cancer
liver - hepatic pain + jaundice
Lung - cough
regional lymph nodes
Peritoneum - Sister Mary Joseph nodule (cancer in the umbilicus)
Signs to find on abdominal exam
abdominal mass
tenderness + distension
Tests for colorectal cancer
faecal occult blood test - detects minute amounts of blood in faeces
Bloods - anaemia/ tumour markers (CEA) but can be non-specific (if it goes down to 0 during chemo - monitor risk of recurrence)
Investigations for colorectal cancer
colonoscopy - under sedation - visualise lesions + remove small polyps
CT colonoscopy - can’t do colonoscopy + less invasive = identify any lesions
MRI - depth of invasion of tumour + choose between chemo or surgery
CT CAP - staging prior to treatment
How is colorectal cancer managed
Mainly surgery
Sometimes stent until chemo/ surgery
resection of the primary anastomosis for right + transverse colon
Hartmann’s procedure for let sided obstruction
what is pancreatic cancer
common + v lethal (v late presentation)
commonest form is pancreatic ductal adenocarcinoma
pancreatic cancer epidemiology
incidence higher in western countries
rare before 45 yrs old
incidence + mortality are pretty close = very lethal
risk factors for pancreatic cancer
chronic pancreatitis = 18 fold increase risk
Type 2 diabetes
smoking
family history
Inherited syndromes (eg. hereditary pancreatitis)
pathogenesis of pancreatic cancer
intraepithelial neoplasias (like polyps) - microscopic - get more malignant + pancreatic epithelium mutates into cancerous cells
clinical presentation of pancreatic cancer in head
jaundice - invasion/ compression of bile duct (cancer at head of pancreas)
weight loss - anorexia/ malabsorption
pain - advanced/ if radiates to back = unresectable
gastrointestinal bleeding - duodenal invasion
presentation of body + tail of pancreas
jaundice is uncommon insidious marked weight loss + back pain Vomiting sometimes - invasion of duodeno- jejunal flexure Most unresectable at time of diagnosis
how to diagnose pancreatic cancer
tumour marker CA19-9 - elevated
ultrasonography - identify tumours/ dilated bile ducts/ liver metastasis
dual phase CT - predicts resectability
how to investigate pancreatic cancer
MRI - predicts resectability
MRCP - ductal images without complications of ERCP
ERCP - double duct sign/ biliary stunting to relieve jaundice
EUS - detection of small tumours before chemo (can’t resect)
liver cancer types
hepatic cellular cancer (of hepatocytes)
cholangiocarcinoma - of bile duct (where hepatic duct diverges)
gallbladder cancer - spreads quickly
colorectal cancer - liver metastasis
primary liver cancer statistics
70/90% have underlying cirrhosis
4-6 months survival without intervention
5-15% suitable for surgery
treatment options of liver cancer
TACE - small catheters into blood supply of tumour
feed drugs into tumour + cut off blood supply
surgical excision
gallbladder cancer + treatments
chronic typhoid cancer/ gallstones - underlying causes
5-8 months without intervention
surgical excision
systemic chemo ineffective
cholangiocarcinoma + treatments
ulcerative colitis/ primary sclerosing cholangitis - - underlying causes
less than 6 months without intervention
surgical excision
systemic chemo ineffective but advances with it
secondary liver metastasis + treatments
less than a yr without intervention
systemic chemo improving as treatment option
surgical excision
