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Gastroenterology > GI Cancers > Flashcards

GI Cancers Flashcards

1
Q

Epithelial cancers

A

Squamous cell carcinoma

Adenocarcinona

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2
Q

Neuroendocrine cells

A

Enteroendocrine cells - Neuroendocrine tumours

Interstitial cells of Cajal - GI stromal tumours

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3
Q

Connective tissue cancers

A

Smooth muscle - Leiomyoma/leiomyosarcoma

Adipose tissue - Liposarcomas

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4
Q

Oeseophageal cancer

A

Squamous

  • from normal oesophageal squamous epithelium
  • upper 2/3
  • Acetaldehyde pathway
  • less developed world

Adenocarcinoma

  • from metaplastic columnar epithelium
  • lower 1/3 of oesophagus
  • related to acid reflux
  • more developed world
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5
Q

Reflux to cancer

A

Oesophagitis (inflammation) - 30% of UK population - GORD

Barrett’s (metaplasia) - 5% of GORD - Barrett’s

Adenocarcinoma (neoplasia) - Barrett’s lifetime risk of cancer - 0.5-1%/year

30-100 fold risk of cancer

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6
Q

Barrett’s to Cancer

A

Barrett’s oesophagus - dysplasia (low grade) - dysplasia (high grade) - adenocarcinoma

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7
Q

Barrett’s surveillance

A

BSG guidelines

  • no dysplasia - every 2-3 years
  • LGD - every 6 months
  • HGD - intervention
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8
Q

Oesophageal cancer risk factor

A

Affects the elderly

Male/female - adenocarcinoma 10/1

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9
Q

Oesophageal cancer survival

A 
Late presentation - dysphagia and weight loss
65% palliative
High morbidity and complex surgery 
Poor 5 year survival <20%
Palliative - difficult
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10
Q

Oesophageal diagnosis

A

Endoscopy - biopsy

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11
Q

Oesophageal staging

A

CT

Laparoscopy

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12
Q

Oesophageal treatment plan

A 
Curative 
- neo-adjuvant chemo - radical surgery 
Palliative 
- chemo
- DXT
- stent
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13
Q

Oeseophageal management pathway

A

Diagnosis
Staging
Treatment plan

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14
Q

Oesophagectomy

A

Two stage ivor Lewis approach

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15
Q

Colorectal cancer background

A 
Most common GI cancer in western society 
Lifetime risk
-1 in 10 for men 
-1 in 14 for women 
Generally patients >50 years
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16
Q

Colorectal cancer forms

A

Sporadic - no family history, older population, isolated lesion
Familial - family history, high risk if index case is young (<50) and relative is close (first degree)
Hereditary syndrome - family history, younger, specific gene defects

Histopathology - adenocarcinoma

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17
Q

Colorectal cancer stages

A

APC mutation - Hyperproliferative epithelium
COX2 overexpression - Small adenoma
K-ras mutation - Large adenoma
p53 and loss of 18q - Colon carcinoma

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18
Q

Colorectal cancer risk factors

A 
Past history
-colorectal cancer 
-adenoma, ulcerative colitis, radiotherapy 
Family history 
-first degree relative <55years
-relative with identified genetic predisposition 
Diet/environment 
-smoking
-obesity
-socioeconomic status
19
Q

Colorectal cancer locations

A

2/3 in descending colon and rectum

1/2 in sigmoid colon and rectum (sigmoidoscopy)

20
Q

Caecal and right sided cancer

A 
Iron deficiency anemia most common 
Change of bowel habit (diarrhoea)
Distal ileum obstruction (late)
Palpable mass (late)
21
Q

Left sided and sigmoid carcinoma

A 
PR bleeding, mucus
Thin stool (late)
22
Q

Rectal carcinoma

A

PR bleeding, mucus
Tenesmus (feeling to pass stool)
Anal, perineal, sacral pain (late)
Bowel obstruction (late)

23
Q

Local invasion of colon cancer

A

Late
Bladder symptoms
Female genital tract symptoms

24
Q

Metastasis - colorectal

A 
Late
Liver (hepatic pain, jaundice)
Lung (cough)
Regional lymph nodes
Peritoneum (sister Mary Joseph nodule)
25
Colorectal cancer examination
Primary - Abdo mass - Digital rectal examination - most <12cm dentate and reached by examining finger - rigid sigmoidoscopy - abdominal tenderness and distention - large bowel obstruction Metastasis and complications - hepatomegaly (mets) - monophonic wheeze - bone pain
26
Colorectal cancer investigations
Faecal occult blood -faecal immunochemical test - detect minute amounts of blood in faeces (faecal occult blood) Blood tests - anemia, haematinics - low ferritin - tumour markers - CEA which is useful for monitoring - not diagnostic Colonoscopy - can visualise lesions <5mm - small polyps can be removed - reduce cancer incidence - under sedation CT colonoscopy/colonography - can visualise lesions >5mm - no need for sedation - less invasive - if lesion identified needs colonoscopy for diagnosis
27
Colorectal cancer imaging tests
MRI rectal - rectal cancer (advanced) - Depth of invasion, mesorectal lymph node involvement - no bowel prep or sedation - help choose between preoperative chemoradiotherapy or straight to surgery CT chest/Abdo/pelvis -staging prior to treatment
28
Colorectal cancer management
Surgery Obstructing colon carcinoma -right and transverse colon (don’t usually obstruct) - resection and primary anastomosis -left sided obstruction —Hartman’s procedure - proximal end colostomy (+/- reversal in 6 months) —primary anastomosis —palliative stent
29
Colonic arterial supply
``` Middle colic artery Right colic artery Ileocolic artery Left colic artery Sigmoid artery ```
30
Resection of right colon cancer
Right hemicolectomy | Extended right hemicolectomy
31
Resection of left sided cancer
Anastomosis
32
Resection of rectal cancer
Connect rectum to anus
33
Pancreatic cancer epidemiology
Relatively common and highly lethal Commonest form is pancreatic ductal adenocarcinoma 80-85% late presentation - median survival less than 6 months - 5 year survival 0.4-5% 15-20% have resectable disease - median survival 11-20 months - 5 year survival 20-25% - virtually all patients dead within 7 years of surgery Incidence increase in western/industrialised countries
34
Pancreatic cancer risk factors
``` Chronic pancreatitis Type II DM Diet Occupation Smoking Family history ```
35
Pancreatic cancer pathogenesis
Pancreatic intraepithelial neoplasias - PDAs evolve through non-invasive neoplastic precursor lesions - PanINs are microscopic (<5mm diameter) and not visible to imaging a - epigenetic alterations along the way
36
Pancreatic cancer presentation
Head - at least 2/3 - jaundice -painless, palpable gallbladder - weight loss - anorexia, malabsorption, diabetes - pain 70% at time of diagnosis - epigastrium, radiates to back 25% - 5% atypical attack of acute pancreatitis - advanced - duodenal obstruction result in persistent vomiting - GI bleeding Body or tail - insidious and asymptomatic - more advanced at diagnosis - marked weight loss with back pain in 60% - jaundice uncommon - vomiting sometimes at late stage - most unresectable at diagnosis
37
Pancreatic cancer investigations
Tumour marker CA19-9 - falsely elevated in pancreatitis, hepatic dysfunction and obstructive jaundice - concentrations >200 U/ml confer 90% sensitivity - concentrations in thousands - high specificity Dual phase CT (most) - predict respectability in 80-90% cases - contiguous organ invasion - distant metastases ERCP - confirm double duct sign - aspiration/brushing of bile duct system - therapeutic modality - biliary stenting to relieve jaundice
38
Pancreatic cancer resections
HOP and TOP resections Head - Whipple procedure Tail - distal pancreatectomy
39
Liver cancers
Hepatocellular - cancer of liver itself Cirrhosis hep B/C Cholangiocarcinoma - bile duct Gall bladder - spread quickly
40
Primary liver cancer
Hepatocellular carcinoma 70-90% have underlying cirrhosis, aflatoxin Median survival without resection 4-6 months 5 year survival <5% Systemic chemotherapy ineffective Optimal resection surgical excision without curative intent - 5 year survival more than 30% 5-15% suitable for surgery
41
Gallbladder cancer
Chronic typhoid infection Median survival without resection 5-8 months Systemic chemotherapy ineffective Optimal resection surgical excision with curative intent 5 year survival stage II 64%, stage III 44%, stage IV 8% <15% suitable for surgery
42
Cholangiocarcinoma
Liver fluke or choledochal cyst Median survival without resection <6 months 5 year survival <5% Systemic chemotherapy ineffective Optimal resection surgery excision with curative intent 5 year survival 20-40% 20-30% suitable for surgery
43
Secondary liver metastases
``` 15-20% synchronous, 25% metachronous Median survival without resection <1% 5 year survival 0% Systemic chemotherapy improving Optimal resection surgical excision with curative intent 25% suitable for surgery ```

Gastroenterology (11 decks)

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