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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
Q

Colorectal cancer examination

A

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
Q

Colorectal cancer investigations

A

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
Q

Colorectal cancer imaging tests

A

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
Q

Colorectal cancer management

A

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
Q

Colonic arterial supply

A 
Middle colic artery
Right colic artery
Ileocolic artery
Left colic artery
Sigmoid artery
30
Q

Resection of right colon cancer

A

Right hemicolectomy

Extended right hemicolectomy

31
Q

Resection of left sided cancer

A

Anastomosis

32
Q

Resection of rectal cancer

A

Connect rectum to anus

33
Q

Pancreatic cancer epidemiology

A

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
Q

Pancreatic cancer risk factors

A 
Chronic pancreatitis 
Type II DM
Diet
Occupation 
Smoking 
Family history
35
Q

Pancreatic cancer pathogenesis

A

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
Q

Pancreatic cancer presentation

A

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
Q

Pancreatic cancer investigations

A

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
Q

Pancreatic cancer resections

A

HOP and TOP resections

Head - Whipple procedure
Tail - distal pancreatectomy

39
Q

Liver cancers

A

Hepatocellular - cancer of liver itself
Cirrhosis hep B/C
Cholangiocarcinoma - bile duct
Gall bladder - spread quickly

40
Q

Primary liver cancer

A

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
Q

Gallbladder cancer

A

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
Q

Cholangiocarcinoma

A

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
Q

Secondary liver metastases

A 
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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