GI Cancers Flashcards
What is a cancer?
“A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems”
What is a primary cancer?
Arising directly from the cells in an organ
What is a secondary cancer?
Spread from another organ, directly or by other means (blood or lymph)
What are the 6 hallmarks of cancer?
- Evading growth suppressors
- Activating invasion and metastasis
- enabling replicative immortality
- Inducing angiogenesis
- Resisting cell death
- Sustaining proliferative signalling
SAAIIL
1. Self Sufficiency
2. Avoid apoptosis
3. Angiogenesis
4. Invasion and metastasis
5. Insensitive to anti-growth signals
6. Limitless division
What type of disease is cancer?
Genetic disease
What is the most common GI tract cancer?
Adenocarcinoma
What is a cancer of squamous epithelial cells called?
Squamous Cell Carcinoma (SCC)
What is a cancer of the glandular epithelium called?
Adenocarcinoma
What are cancers of enteroendocrine cells called?
Neuroendocrine Tumours (NETs)
What are cancers of the interstitial cells of Cajal called?
Gastrointestinal Stromal Tumours (GISTs)
What are cancers of smooth muscle called?
Leimyoma / leimyosarcomas
What are cancers of adipose tissue called?
Liposarcoma
How to judge whether diseases are suitable for screening?
Wilson and Jungner Criteria
What is meant by cancer screening?
Testing of asymptomatic individuals to identify cancer at an early stage.
What is a FIT?
Faecal immunochemical test - detects haemoglobin in faeces - screens for colorectal cancer
What does a sigmoidoscopy do?
Removes polyps to reduce the risk of future cancers
What are patients with FAP offered yearly to help screen for colorectal cancer?
OesophagoGastroDuodenoscopy - OGD and colonoscopies
Patients with which conditions are offered regular endoscopies to screen for oesophageal cancer?
Barrett’s Oesophagus
Low to High grade dysplasia
Is pancreatic and gastric cancer screened for?
No as no test meets the W and J criteria
What screening is offered to patients with viral hepatitis or alcoholic hepatitis?
Regular ultrasound and AFP to check for hepatocellular cancer
What are the three stages of a patients cancer journey?
Diagnosis
Staging
Treatment
What is the 2-week-wait cancer pathway?
devised to streamline referral for those with symptoms suggestive of cancer in order to allow diagnosis at an earlier stage, reduce cancer survival inequality around the country and ultimately reduce cancer-related mortality
List those individuals in the cancer MDT?
Pathologist
Radiologist
Palliative care
Oncologist
Gastroenterologist
Cancer Nurse Specialist
Surgeon
What is the role of the pathologist in cancer?
Confirms the diagnosis of cancer using biopsy samples.
What are cancers of secretory cells called?
Adenocarcinoma
What does the pathologist provide?
Histological typing - provides information on what type of cell the cancer comes from
What is molecular typing?
when the pathologist determines what mutation the cancer has
How can a pathologist tell how aggressive the cancer is?
Determined by how ‘abnormal’ cells & their nuclei are and how actively they are dividing.
What system does a radiologist used to determine the tumour grade?
TNM:
Tumour - size
Nodes - lymph node involvement
Metastasis - spread of cancer
What are two interventional radiographic strategies that a radiologist might use to assist in the patients care?
Percutaneous biopsies
Radiological stents
What is the role of the surgeon in the cancer MDT?
Performs operation and cares for patient in perioperative period
What does the oncologist do in the cancer MDT?
Decides on whether chemotherapy, radiotherapy or other systemic therapy is appropriate.
Coordinates the overall treatment plan
Should chemotherapy come before surgery (neoadjuvant) or after (adjuvant)?
Which part of the oesophagus does squamous cell carcinoma affect?
The upper 2/3rds
Where in the world is squamous cell carcinoma most common?
The less developing world
Where in the world is Adenomcarcinoma most common?
Developed world (more common in men and affects elderly)
Which part of the the oesophagus does adenocarcinoma affect?
Lower 1/3rd
What happens to the squamous epithelium when a patient has an adenocarcinoma?
Squamous epithelium becomes columnar - metaplasia
What condition is adenocarcinoma related to?
Acid reflux - Barretts Oesophagus
What are the stages of oesophageal cancer?
Oesophagitis -> Barretts oesophagus -> Adenocarcinoma
What is oesophagitis?
Inflammation of the oesophagus
What type of cell change occurs in Barrett’s oesophagus?
Intestinal metaplasia
What type of cell change occurs in Adenocarcinoma?
Squamous -> columnar = becomes neoplasmic
What are the stages of progression from Barret’s Oesophagus to Adenocarcinoma?
Metaplasia → mild → moderate → severe dysplasia’ → cancer
What is the most common presentation of oesophageal cancer?
Dysphagia - difficulty swallowing
Why does late presentation of symptoms occur in oesophageal cancer?
Significant cancer growth needs to occur before dysphagia develops (difficulty swallowing).
Often have metastases
Why is particularly important to screen patients with reflux disease or Barrett’s oesophagus?
Most common symptoms of Oesophageal Cancer is dysphagia
Significant cancer growth needs to occur before dysphagia develops (difficulty swallowing).
What happens if a lesion is found during an OGD?
If lesion is found → biopsy taken to confirm the diagnosis.
What are four investigations which can be done to stage the cancer?
CT of chest & abdomen
PET-CT scan to exclude metastases
Staging laparoscopy - To identify liver & peritoneal metastases
Endoscopic ultrasound - Via oesophagus to clarify depth of invasion & involvement of local lymph nodes
What are the two treatment pathways for oesophageal cancer?
Curative or palliative
Describe the curative treatment option for GI cancer?
Neoadjuvant chemotherapy and then oesophagectomy (stomach pulled up into chest and becomes oesophagus)
Describe the palliative treatment plan for GI Cancers?
Palliative chemo, steroid to reduce oedema around tumour and stent to allow easy swallowing
What is the major driver of gastric adenocarcinoma?
Chronic gastritis is the major driver
How can H.pylori cause gastric adenocarcinoma?
due to chronic acid overproduction
How can pernicious anaemia cause gastric adenocarcinoma?
autoantibodies against parts & products of parietal cells
How can a partial gastrectomy cause gastric cancer?
leads to bile reflux
Which viral infection can increase the risk of gastric cancer?
Epstein-Barr virus infection
What lifestyle factors can increase the risk of gastric cancer?
High salt diet & smoking
Which type of gastric cancer can be heritable?
diffuse-type gastric cancer due to E-cadherin mutations
What is the pathogenesis of gastric cancer?
Chronic gastritis → Intestinal metaplasia → Dysplasia → Malignancy
What are the most common clinical presentations in patients with gastric cancer? ALARMS55
Anaemia Loss of weight or appetite Abdominal mass on examination Recent onset of progressive symptoms Melaena or haematemesis Swallowing difficulty 55 years of age or above
How is gastric cancer diagnosed?
similar to oesophageal cancer: endoscopy + biopsy
How is gastric cancer staged?
CT of the chest, abdomen & pelvis will provide information on distant lesions
PET-CT
Diagnostic laparoscopy - peritoneal & liver metastases disease prior to full operation
Endoscopic ultrasound - will give most detail about local invasion & node involvement
What is the treatment plan for patients with GI cancers?
- neoadjuvant chemo - reduce size of tumour
- Surgery
- Adjuvant chemo to reduce risk of relapse
What surgery is performed when the gastric tumour is at the oesophago-gastric junction?
Oesophago-gastrectomy
What surgery is performed when the gastric tumour is close (<5cm) to the oesophago-gastric junction?
Total gastrectomy
What surgery is performed when the gastric tumour further (>5cm) from the oesophago-gastric junction?
Subtotal gastrectomy
What are the palliative approaches taken for gastric cancer patients?
Stenting or Gastro-jejunal anastomosis
