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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

A

aspirin

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
Q

what are the clinical presentations/ symptoms of caecal and right sided cancer

A

iron def anaemia
change of bowel habit - diarrhoea
distal ileum obstruction - late
palpable mass

26
Q

what are the clinical presentations with left sided and sigmoid carcinoma

A

pr bleeding , mucus

thin stool - late

27
Q

what are the clinical presentations of rectal carcinoma

A

pr bleeding, mucus
tenesmus
anal, perineal and sacral pain - late

28
Q

what can you see with late local invasion

A

bladder symtoms

female genital tract symptoms

29
Q

what are late metastasis clinical presentations

A

liver - hepatic, jaundice
lung
regional lymph nodes
peritoneum

30
Q

what are the signs of primary cancer

A

abdominal mass
dre most <12cm and reached by examining finger
rigid sigmoidoscopy
abdominal tenderness and distension - large bowel obstruction

31
Q

what are the signs of metastasis and complications in colorectal cancer

A

hepatomegaly
monophonic wheeze
bone pain

32
Q

investigations for colorectal cancer

A

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
Q

what is the best way to find /diagnose colorectal tumours

A 
colonoscopy - 
can visualise lesions <5mm
small polyps can be removed
reduce cancer incidence
usually performed under sedation
34
Q

why are ct coloscopy/ colonography preferred for elderly

A

can visualise lesions>5mm
no need for sedation
less invasive and better tolerated
if lesions identified patients needs colonscopy for diagnosis

35
Q

other imaging techniques for colorectal cancer

A

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
Q

how is colon cancer managed

A

primary managed by surgery

stent/radiotherapy/chemotherapy?

37
Q

how to manage obstructing colon carcinoma

A 
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
Q

epidemiology of pancreatic cancer

A 
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
Q

risk factors for pancreatic cancer

A 
chronic pancreatitis
type2 dm
cholelithiasis, previous gastric surgery and pernicious anaemia
diet
occupation
smoking
7-10% have family history
40
Q

mutation in genes found in hereditary pancreatitis

A

prss1
spink1
cftr

41
Q

pathogenesis for pancreatic cancer

A

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
Q

clinical presentation of pancreatic cancer in head of pancreas

A

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
Q

clinical presentation of carcinoma of body/tail of pancreas

A

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
Q

how to investigate pancreatic cancers

A

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
Q

how to manage pancreastic cancer

A

hop resection

top resection

46
Q

4 reasons for liver operations

A

hepatocell cancer
cholangiocarcinoma
gallbladder cancers
colorectal cancer

47
Q

aetiology of primary liver cancer (hepatocellular cancer)

A

70-90% have underlying cirrhosis
aflatoxin
median survival without treatment = 4-6mths

48
Q

gallbladder cancer aetiology

A 
unknown
gs?
porcelain gb
chronic typhoid infection
median survival without treatment 5-8 mths
systemic chemotherapy is ineffective
49
Q

aetiology of cholangiocarcinoma

A 
psc and uc
liver fluke - clonorchis sinesis
choledochal cyst
median survival without treatment ~ <6m
systemic chemotherapy ineffective

brs2 (65 decks)

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