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Gastro Yr 2 > GI Cancers > Flashcards

GI Cancers Flashcards

1
Q

what is cancer

A

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

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2
Q

what is primary cancer

A

Arising directly from the cells in an organ

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3
Q

what is secondary cancer or metastasis

A

Spread to another organ, directly or by other means (blood or lymph)

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4
Q

what is squamous cell carcinoma

A

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)

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5
Q

what is adenocarcinoma

A

from metaplastic columnar epithelium
lower 1/3 of oesophagus
related to acid reflux (more common in developed world)

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6
Q

what is the progression from reflux to cancer

A

oesophagitis (inflammation) to Barrett’s (metaplasia) to adenocarcinoma (neoplasia)

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7
Q

How does Barrett’s go to cancer

A

Barrett’s metaplasia to low grade dysplasia to high grade dysplasia

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8
Q

oesophageal cancer epidemiology

A

affects the elderly
more common in men (10:1)
9th most common cancer

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9
Q

Is there high survival from oesophageal cancer?

A 
presents late
dysphagia + weight loss
high morbidity
poor 5 yr survival <20%
mostly palliative
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10
Q

what is the treatment plan for oesophageal cancer

A

Stage the cancer
CT/ laparoscopy
OGD if suspicious there is a tumour there
neo-adjuvant chemo for all adenocarcinomas + radical surgery

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11
Q

what is colorectal cancer

A

most common GI cancer in western societies
generally >50
third most common cancer cause of death in men + women

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12
Q

Forms of colorectal cancer

A

sporadic
familial
hereditary syndrome

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13
Q

Forms of colorectal cancer

A

sporadic
familial
hereditary syndrome

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14
Q

sporadic form of colorectal cancer

A

absence of family history
older pop
isolated lesion

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15
Q

familial form of colorectal cancer

A

family history
higher risk index if young
relative is close (1st degree)

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16
Q

hereditary form of colorectal cancer

A

family history
younger age of onset
specific gene defects

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17
Q

how does colorectal cancer progress (mechanism)

A

APC mutation -> COX-2 overexpression (hyperproliferative epithelium) -> K-ras mutation -> p53 mutation -> colon carcinoma

18
Q

risk factors of colorectal cancer

A

past history - ulcerative colitis/ colorectal cancer etc
family history - 1st degree relative
diet/ environmental - smoking/ obesity/ SES

19
Q

clinical presentation of colorectal cancer

A

2/3 in descending colon + rectum

1/2 in sigmoid colon + rectum

20
Q

symptoms of colorectal cancer

A

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

21
Q

Late local invasion symptoms of colorectal cancer

A

bladder symptoms

female genital tract symptoms

22
Q

metastastic symptoms of colorectal cancer

A

liver - hepatic pain + jaundice
Lung - cough
regional lymph nodes
Peritoneum - Sister Mary Joseph nodule (cancer in the umbilicus)

23
Q

Signs to find on abdominal exam

A

abdominal mass

tenderness + distension

24
Q

Tests for colorectal cancer

A

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)

25
Q

Investigations for colorectal cancer

A

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

26
Q

How is colorectal cancer managed

A

Mainly surgery
Sometimes stent until chemo/ surgery
resection of the primary anastomosis for right + transverse colon
Hartmann’s procedure for let sided obstruction

27
Q

what is pancreatic cancer

A

common + v lethal (v late presentation)

commonest form is pancreatic ductal adenocarcinoma

28
Q

pancreatic cancer epidemiology

A

incidence higher in western countries
rare before 45 yrs old
incidence + mortality are pretty close = very lethal

29
Q

risk factors for pancreatic cancer

A

chronic pancreatitis = 18 fold increase risk
Type 2 diabetes
smoking
family history
Inherited syndromes (eg. hereditary pancreatitis)

30
Q

pathogenesis of pancreatic cancer

A

intraepithelial neoplasias (like polyps) - microscopic - get more malignant + pancreatic epithelium mutates into cancerous cells

31
Q

clinical presentation of pancreatic cancer in head

A

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

32
Q

presentation of body + tail of pancreas

A 
jaundice is uncommon
insidious
marked weight loss + back pain
Vomiting sometimes - invasion of duodeno- jejunal flexure 
Most unresectable at time of diagnosis
33
Q

how to diagnose pancreatic cancer

A

tumour marker CA19-9 - elevated
ultrasonography - identify tumours/ dilated bile ducts/ liver metastasis
dual phase CT - predicts resectability

34
Q

how to investigate pancreatic cancer

A

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)

35
Q

liver cancer types

A

hepatic cellular cancer (of hepatocytes)
cholangiocarcinoma - of bile duct (where hepatic duct diverges)
gallbladder cancer - spreads quickly
colorectal cancer - liver metastasis

36
Q

primary liver cancer statistics

A

70/90% have underlying cirrhosis
4-6 months survival without intervention
5-15% suitable for surgery

37
Q

treatment options of liver cancer

A

TACE - small catheters into blood supply of tumour
feed drugs into tumour + cut off blood supply
surgical excision

38
Q

gallbladder cancer + treatments

A

chronic typhoid cancer/ gallstones - underlying causes
5-8 months without intervention
surgical excision
systemic chemo ineffective

39
Q

cholangiocarcinoma + treatments

A

ulcerative colitis/ primary sclerosing cholangitis - - underlying causes
less than 6 months without intervention
surgical excision
systemic chemo ineffective but advances with it

40
Q

secondary liver metastasis + treatments

A

less than a yr without intervention
systemic chemo improving as treatment option
surgical excision

Gastro Yr 2 (7 decks)

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