GI Cancers Flashcards
What are the cancers of the Epithelial cells?
Squamous “Glandular Epithelium” - Squamous cell carcinoma, Adenocarcinoma (most common).
What are the cancers of the Neuroendocrine cells?
Enterocendocrine cells - Neuroendocrine Tumours (NETs)
Interstitial cells of Cajal - Gastrointestinal Stromal Tumours (GISTs)
What are the cancers of Connective tissue?
Smooth muscle - Leiomyoma/leiomyosarcomas
Adipose tissue - Liposarcomas.
What type of muscle do you have in the oesophagus?
Skeletal
Skeletal/smooth
Smooth
Which type of Oesophageal cancer is more common in the less developed world?
Squamous Cell Carcinoma
From normal oesophageal squamous epithelium
Upper 2/3
Acetaldehyde pathway
What type of Oesophageal cancer is more common in the more developed world?
Adenocarcinoma
From metaplastic columnar epithelium
Lower 1/3 of oesophagus
Related to acid reflux
What percentage of the UK population have GORD?
30%
What is the pathway from Barret’s oesophagus to Adenocarcinoma?
Barrett’s oesophagus metaplasia
Dysplasia- low grade
Dysplasia- High grade
Adenocarcinoma
What are the guidelines for Barrett’s surveilance?
No dysplasia → Every 2-3 years
LGD → every 6 months
HGD → intervention
What is the ratio of male to female adencarcinoma of the oesophagus ratio?
M/F - 10:1
Who does Oesophageal cancer mainly affect?
Squamous- adenocarcinoma
9th most common cancer
Affects the elderly
What are the commonest presentations of Oesophageal cancers
Late presentation - dysphagia & wt loss 65% palliative High morbidity & complex surgery Poor 5-year survival <20% Palliation - difficult
What is the management pathway for oesophageal cancer?
Diagnosis - Endoscopy -> Biopsy
Staging - CT scan, Lapraroscopy, PET scan, EndoscopicUltraSound EUS.
Treatment Plan;
Curative - Neoadjuvant chemo, Radical surgery.
Palliative - chemo, stent, DXT (radiotherapy)
What happens in an Oesophagectomy?
Two stage Ivor Lewis approach
Who is affected by Colorectal cancer?
Most common GI cancer in Western Societies
Third most common cancer death in men & women
Lifetime risk
1 in 10 for men
1 in 14 for women
Generally affects patients > 50 years (>90% of cases)
What are the different forms of Colorectal cancer?
Sporadic
Absence of family history, older population, isolated lesion
Familial
Family history, higher risk if index case is young (<50years) and the relative is close (1st degree)
Hereditary syndrome
Family history, younger age of onset, specific gene defects
e.g. Familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal cancer (HNPCC or Lynch syndrome)
Histopathology - Adenocarcinoma
What are the risk factors for 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
Where do colorectal cancers occur?
⅔ in descending colon and rectum
½ in sigmoid colon and rectum (i.e. within reach of flexible sigmoidoscopy)
How does a Caecal & right sided cancer present?
Iron deficiency anaemia (most common) Change of bowel habit (diarrhoea) Distal ileum obstruction (late) Palpable mass (late)
How does a Left sided & sigmoid carcinoma present?
PR bleeding, mucus, thin stool.
How does a Rectal Carcinoma present?
PR bleeding, mucus
Tenesmus (sensation you want to open bowels but nothing comes out)
Anal, perineal, sacral pain (late)