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BRS > GI Cancers > Flashcards

GI Cancers Flashcards

1
Q
  • What does a ‘primary’ cancer mean?

- What does ‘secondary/metastasis’ mean when referring to cancers?

A

Cancer arising from cells in an organ

Spread from another organ, directly or by other means (blood, lymph)
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2
Q
  • What are the 6 hallmarks of cancer?
A

Sustaining proliferative signalling

Resisting cell death

Evading growth suppressors

Inducing angiogenesis

Activating invasion and metastasis

Enabling replicative immortality
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3
Q
  • What are the 2 ‘emerging’ and 2 ‘enabling’ hallmarks?
A

emerging - Deregulating cellular energetics, Avoidance of immune destruction

enabling - Tumour-promoting inflammation, Genome instability and mutation
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4
Q
  • What cells are involved in Squamous Cell Carcinoma and Adenocarcinomas respectively?
  • What cells are involved in Neuroendocrine Tumours and Gastrointestinal Stromal Tumours respectively?
  • What cells are involved in Leiomyomas and Liposarcomas respectively?
A

Squamous cells, “Glandular epithelium”

Enteroendocrine cells, Interstitial cells of Cajal

Smooth muscle, Adipose tissue

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5
Q
  • What is the most common cancer type in women?
  • What is the most common cancer type in men?
  • What is the most common cancer type involved in deaths?
A

Breast cancer

Prostate

Lung cancer
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6
Q
  • What is meant by a Cancer of Unknown Primary?
  • Do pancreatic cancers tend to metastasise early?
  • Which GI cancer has the largest overall 5-year survival rate?
A

Cancer where there is metastasis but you never find out where the primary has come from

Yes

Colorectal- 60%

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7
Q
  • What are the 7 Wilson & Jungner criteria for cancer screening?
A

The condition sought should be an important health problem

There should be an accepted treatment for patients with recognised disease

Facilitated for diagnosis and treatment should be available

There should be a recognisable latent or early symptomatic stage

There should be a suitable test or examination

Test should be acceptable to the population

The natural history of the condition , including development from latent to declared disease, should be adequately understood
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8
Q
  • What are the 2 screening methods for colorectal cancer?

- How would you screen for oesophageal cancer?

A

Faecal immunochemical test (FIT) - detects haemoglobin in faeces, every 2 years for everyone aged 60-74
One-off sigmoidoscopy - for everyone aged >55 to remove polyps

Regular endoscopy to patients with: Barett's oesophagus, Low-high grade dysplasia
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9
Q
  • How would you screen for pancreatic and gastric cancer?

- How would you screen for hepatocellular cancer?

A

No test exists that meets the W & J criteria, Depends on incidence - Japan screens for gastric cancer

Regular ultrasound and AFP (alpha-faeto protein found in high abundance in patients with this cancer) for high risk individuals with cirrhosis eg Viral hepaptitis, Alcoholic hepatitis
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10
Q
  • What are the team members of a Cancer MDT?
A

Pathologist

Radiologist

Cancer Nurse Specialist

Palliative Care

Gastroenterologist

Oncologist

Surgeon
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11
Q
  • What do the pathologists do?
A

Confirm diagnosis of cancer using biopsy samples

Provide histologic typing - What type of cell does the cancer come from?

Provide molecular typing - What mutations does the cancer have?

Provide tumour grade - How aggressive is the cancer?
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12
Q
  • What do the radiologists do?
A

Reviews scans - confirm diagnosis and gives possible diagnoses

Provides radiological tumour stage (TNN) - how far has the cancer spread

Provides re-staging after treatment

Interventional Radiology - Percutaneous biopsies and Radiological stents
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13
Q
  • What does the surgeon do?

- What does the gastroenterologist do?

A

Decides whether surgery is appropriate
Performs operation and cares for patient in perioperative period

Endoscopy - diagnostic and therapeutic
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14
Q
  • What does the oncologist do?

- what do the MDT ultimately decide together?

A

Decides on whether chemotherapy, radiotherapy or other systemic therapy is appropriate
Coordinates overall treatment plan - Should chemotherapy come before surgery (neoadjuvant) or after (adjuvant)?

MDT decides whether plan should be for radical (curative) or palliative therapy or palliative care
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15
Q
  • Describe the pathogenesis of oesophageal cancer
A

Squamous cell carcinoma- Upper 2/3 and develop from normal oesophageal squamous epithelium

Adenocarcinoma

   - Lower 1/3 of oesophagus, Squamous epithelium that has become columnar (metaplastic)
   - Related to acid reflux
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16
Q
  • How much of the population is affected by oesophagitis?
  • What disease is oesophagitis a progression from?
  • What condition does oesophagitis lead to?
A

30%

GORD - Gastro-oesophageal reflux disease

Barett's Oesophagus (intestinal metaplasia)
17
Q
  • Describe the progression process of Barett’s oesophagus to cancer
  • What do 0.5-11% patients with Barett’s per year then go on to have?
  • What is meant by dysphagia?
A

Metaplasia → mild → moderate → severe dysplasia → cancer

Adenocarcinoma

Difficulty swallowing (commonest symptom)
18
Q
  • Why is there late presentation of oesophageal cancer?
A

Significant cancer growth needs to occur before dysphagia develops

Often have metastases

Most patients deemed unfit for surgery at diagnosis (malnourished)
19
Q
  • How would you diagnose oesophageal cancer?
A

Upper GI endoscopy (Oesophagogastroduodenoscopy, OGD)

Then biopsy it if a lesion is found
20
Q
  • Which investigations are used to stage the cancer?
A

CT of chest and abdomen

PET-CT scan to exclude metastases

Staging laparoscopy - to identify liver and peritoneal metastases

Endoscopic ultrasound - via oesophagus to clarify depth of invasion and involvement of local lymph nodes
21
Q
  • If the tumour is surgically resectable with no distant metastases and patient is fit enough to undergo major surgery, describe the treatment pathway followed?
  • If not, describe the alternative treatment pathway that is followed for the patient?
A

Curative - Neoadjuvant chemotherapy followed by oesophagectomy

Palliative - palliative chemotherapy + steroids (dexamethasone - reduces oedema around tumour) + stents (to increase air flow)
22
Q
  • Describe the most common pathogenesis of gastric adenocarcinoma
A

Chronic gastritis is the major driver where most commonly H.pylori infection due to chronic acid overproduction

23
Q
  • Describe some of the other pathogeneses of gastric adenocarcinoma
A

Pernicious anaemia - autoantibodies against parts and products of parietal cells

Partial gastrectomy - leading to bile reflux

Epstein-Barr virus infection 

Family history (including heritable diffuse type gastric cancer due to E-cadherin mutations)

High salt diet and smoking
24
Q
  • Describe the progression from chronic gastritis to cancer?
A

Chronic gastritis → inflammation and atrophy → mucinous metaplasia → intestinal metaplasia (cells in stomach chnage to those lining intestinal cells) → dysplasia → cancer

25
Q
  • What is the most common symptom of gastric cancer?

- What are some of the ‘red flags’ that patients with gastric cancer tend to show?

A

Dyspepsia - Upper abdominal discomfort after eating or drinking

    Anaemia
    Loss of weight or appetite
    Abdominal mass on examination
    Recent onset of progressive symptoms
    Melaena or haematemesis
    Swallowing difficuly
    55 years of age or above
26
Q
  • What investigations would you carry out to stage the gastric cancer?
A

CT of chest, abdomen and pelvis

PET-CT

Diagnostic laparoscopy - peritoneal and liver metastases disease prior to full operation

Endoscopic Ultrasound - gives most detail about local invasion and node involvement
27
Q
  • Why is neoadjuvant chemotherapy given to patients during treatment of gastric cancer instead of adjuvant?
A

It is used to reduce the tumour size before surgery and then reduce the chance of having metastases

also good to see how the tumour responds- if it responds aggressively better indication on whether surgery would work

28
Q
  • If the tumour is at the oesophago-gastric junction, what surgery will be needed?
  • If the tumour is close (<5cm) to the OG junction, what surgery will be needed?
  • If the tumour is further (>5cm) from the OG junction, what surgery is needed?
A

Oesophago-gasterectomy

Total gasterectomy - cannot save the sphincter mechanism

Subtotal gasterectomy or distal gasterectomy

BRS (41 decks)

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