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GI cancers Flashcards

1
Q

what is secondary cancer/metastasis

A

spread to another organ directly or by other means e.g blood or lymph

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2
Q

what are cancers of squamous epithelial cells called

A

squamous cell carcinoma

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3
Q

what are glandular epithelium cells called

A

adenocarcinoma

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4
Q

what are enterocendocrine cell tumours called

A

neuroendocrine tumours

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5
Q

what are interstitial cell of cajal tumours called

A

gastrointestinal stromal tumours

GISTs

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6
Q

what are smooth muscle cell cancers called

A

leiomyoma/ leiomyosarcomas

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7
Q

what are adipose tissue cancers called

A

liposarcomas

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8
Q

describe squamous cell carcinomas in oesophageal cancers

A

arise from normal oesophageal squamous epithelium at upper 2/3
caused by acetaldehyde pathway (alcohol)
more common in less developed world

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9
Q

describe adenocarcinoma in in oesophageal cancer

A

occur in lower 1/3 of oesophagus
from metaplastic columnar epithelium
related to acid reflex
more common in more developed world

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10
Q

what is oesophagitis

A

inflammation

caused by GORD - 30% of uk population

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11
Q

what is barrets oesophagus

A

metaplasia - potential for cancer

of 30% with oesophagitis 5% will get barrets

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12
Q

what is the bsg guidelines for barrets surveillance

A

no dysplasia - every 2-3 yrs
lgd - every 6 moths
hgd - intervention

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13
Q

what is the male:female ratio for adenocarcinoma of oesophagus

A

10:1

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14
Q

what are some common facts of og cancers

A 
late presentation- dysphagia and weightloss
65% palliative
high morbidity and complex surgery
poor 5 yr survival <20%
palliation = difficult
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15
Q

how to diagnose og cancers

A

endoscopy and biopsy

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16
Q

how can you stage cancers

A

ct scan
laparoscopy
eus?
pet scan? - to pick up matastases

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17
Q

treatment plan for patients with og cancers

A 
curative = neo adjuvant chemo
radical surgery
palliative  = 
dxt
stent
chemo
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18
Q

what is an oesophagectomy

A

remove upper part of stomach and oesophagus

rejoin

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19
Q

what is colorectal cancer

epidemiology

A

most common gi cancer in western societies
3rd most common cancer death cause in men and women
lifetime risk 1/10 men and 1/14 women
generally affects patients >50yrs

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20
Q

what are the form of colorectal cancers

A

sporadic - absence of family history, older population and isolated lesion
familial - family history, higher risk if index case is young < 50yrs and relative is close(1st degree)
hereditary syndrome - family history, younger age of onset, specific gene defects e.g fap, hnpcc/lynch sydrome

21
Q

what is the usual histopathology of colorectal cancer

A

adenocarcinoma

22
Q

what can stop the progression of polyps to cancers

23
Q

what are the risk factors for colorectal cancers

A

past history - colorectal cancer
adenoma,uc, radiotherapy
family history - 1st degree relative <55 yrs
relative with genetic predisp
diet/environmental - carcinogenic foods, smoking, obesity, socioeconomic status

24
Q

where are the locations of colorectal cancers

A

2/3 in descending colon and rectum

1/2 in sigmoid colon and rectum - within reach of flexible sigmoidoscopy

25
what are the clinical presentations/ symptoms of caecal and right sided cancer
iron def anaemia change of bowel habit - diarrhoea distal ileum obstruction - late palpable mass
26
what are the clinical presentations with left sided and sigmoid carcinoma
pr bleeding , mucus | thin stool - late
27
what are the clinical presentations of rectal carcinoma
pr bleeding, mucus tenesmus anal, perineal and sacral pain - late
28
what can you see with late local invasion
bladder symtoms | female genital tract symptoms
29
what are late metastasis clinical presentations
liver - hepatic, jaundice lung regional lymph nodes peritoneum
30
what are the signs of primary cancer
abdominal mass dre most <12cm and reached by examining finger rigid sigmoidoscopy abdominal tenderness and distension - large bowel obstruction
31
what are the signs of metastasis and complications in colorectal cancer
hepatomegaly monophonic wheeze bone pain
32
investigations for colorectal cancer
fit( faecal immunochemical test) - detects minute amounts of blood in faeces (faecal occult blood) guaiac test (hemoccult) - based on pseudoperoxidase activity of haematin diet restrictions - avoid red meat, melons, horse radish, vit c and nsaids for 3 days before test blood tests- fbc: anaemia, haematinics - low ferritin tumour markers -cea useful for monitoring
33
what is the best way to find /diagnose colorectal tumours
``` colonoscopy - can visualise lesions <5mm small polyps can be removed reduce cancer incidence usually performed under sedation ```
34
why are ct coloscopy/ colonography preferred for elderly
can visualise lesions>5mm no need for sedation less invasive and better tolerated if lesions identified patients needs colonscopy for diagnosis
35
other imaging techniques for colorectal cancer
rectal cancer - mri pelvis - depth of invasion, mesorectal lymph node involvement no bowel prep or sedation required helps to choose between preoperative chemoradiotherapy or straight to surgery ct of chest/abdo/pelvis - staging prior to treatment
36
how is colon cancer managed
primary managed by surgery | stent/radiotherapy/chemotherapy?
37
how to manage obstructing colon carcinoma
``` right and tranverse colon - resection and primary anastomosis left handed obstruction - - hartmanns procedure proximal end colostomy +- reversal in 6 months primary anastomosis - intraoperative bowel lavage with primary anastomosis - defunctioning ileostomy palliative stent ```
38
epidemiology of pancreatic cancer
``` relatively common and highly lethal commonest form is pancreatic ductal adenocarcinoma 80-85% have late presentation 15-20% have resectable disease higher in western countries rare before 45 4th most common cancer ```
39
risk factors for pancreatic cancer
``` chronic pancreatitis type2 dm cholelithiasis, previous gastric surgery and pernicious anaemia diet occupation smoking 7-10% have family history ```
40
mutation in genes found in hereditary pancreatitis
prss1 spink1 cftr
41
pathogenesis for pancreatic cancer
commonest - pancreatic intraepithelial neoplasias pdas evolve through non invasive neoplastic precursor lesions panINs are microscopic <5mm diameter acquire clonally selected genetic and epigenetic alterations
42
clinical presentation of pancreatic cancer in head of pancreas
jaundice - >90% due to invasion/progression of cbd often painless palplable bladder - courvoisers sign wightloss - anorexia, malabsorption,diabtetes pain - 70% at time of diagnosis epigastrium radiates to back 25% gi bleeding if duodenal invasion or varices secondary to portal/splenic vein occlusion
43
clinical presentation of carcinoma of body/tail of pancreas
develops insidiously and asymptomatic in early stages at diagnosis - more advsnced than lesions at head marked weight loss with backpain in 60% of patients jaundice = uncommon vomiting sometimes occurs in late stage most unresectable at time of diagnosis
44
how to investigate pancreatic cancers
mri imaging - detects and predicts resectability with accuracies similar to ct mrcp - provides ductal images without complications of ercp ercp- confirms typical 'double duct' sign aspiration/brushing of bile duct system therapeutic modality - biliary stenting to relieve jaundice eus - highly sensitive in detection of small tumours assessing vascular invasion fna laparoscopy and laparoscopic us pet
45
how to manage pancreastic cancer
hop resection | top resection
46
4 reasons for liver operations
hepatocell cancer cholangiocarcinoma gallbladder cancers colorectal cancer
47
aetiology of primary liver cancer (hepatocellular cancer)
70-90% have underlying cirrhosis aflatoxin median survival without treatment = 4-6mths
48
gallbladder cancer aetiology
``` unknown gs? porcelain gb chronic typhoid infection median survival without treatment 5-8 mths systemic chemotherapy is ineffective ```
49
aetiology of cholangiocarcinoma
``` psc and uc liver fluke - clonorchis sinesis choledochal cyst median survival without treatment ~ <6m systemic chemotherapy ineffective ```

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