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GI Cancers Flashcards

1
Q

Define carcinoma

A

Malignancy of cells that make up the epithelial lining of skin or tissue lining organs

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2
Q

Define adenocarcinoma

A

Malignancy of glandular cells in epithelial tissue

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3
Q

Define adenoma

A

Benign tumour formed from glandular structures in epithelial tissue

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4
Q

Order of incidence of GI cancers

A
  • breast/prostate (not GI but most common generally)
  • large bowel
  • pancreas
  • oesophagus
  • stomach
  • liver
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5
Q

What cancers generally impact the upper 2/3rd of the oesophagus?

A

Squamous cell carcinomas

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6
Q

What cancers generally effect the lower 1/3rd of the oesophagus?

A

Adenocarcinomas
e.g. Barrett’s oesophagus

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7
Q

Red flags of oesophageal cancer

A
  • progressive dysphagia
    ALARM
  • Anaemia
  • unintentional weight Loss
  • Anorexia
  • Recent onset of progressive symptoms
  • Malaena or palpable mass
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8
Q

Risk factors of oesophageal cancers (carcinomas)

A

Smoking
Alcohol use
Dietary intake e.g hot drinks

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9
Q

Risk factors of oesophageal cancers (adenocarcinoma)

A

Obesity
Reflux disease
Barrett’s oesophagus

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10
Q

what does NICE say are the red flag symptoms for suspected oesophageal malignancy requiring urgent endoscopy are?

A
  • any patient with dysphagia
  • any patient >55 with weight loss and upper abdominal pain, dyspepsia or reflux
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11
Q

Investigations of oesophageal cancers

A
  • blood tests: anaemia
    -oesophagogastroduodenoscopy with biopsy: can determine is benign or malignant
  • **CT chest, abdomen, pelvis **: metastatic spread
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12
Q

Management of oesophageal cancer

A
  • most present with advanced disease > palliative care > oesophageal stent, chemo/radiotherapy
  • nutritional support: thickened fluids, supplements
  • SSC : chemotherapy
  • adenocarcinoma: neoadjuvant chemo or chemoradio followed by oesophagectomy
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13
Q

what does a oesophagectomy involve?

A

removal of tumour, top of stomach + surrounding lymph nodes

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14
Q

What is the most common GI cancer?

A

Large bowel

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15
Q

Why is there a risk of adenocarcinomas in a patient with Barrett’s oesophagus?

A

Increased risk of dysplasia

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16
Q

Presentation of oesophageal cancer

A
  • progressive dysphagia
  • initially are more difficult to swallow solids than fluids but with progression liquids become hard to swallow too
  • odynophagia
  • unexplained weight loss
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17
Q

What is odynophagia?

A

Pain on swallowing

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18
Q

What type of cancer is most common in gastric cancer?

A

Adenocarcinoma

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19
Q

Where is gastric cancer most commonly found in order?

A

Cardia
Antrum
Body
CAB

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20
Q

Classifications of gastric cancer

A

Location:
- cardia gastric cancer: similar presentation to oesophageal cancer
-non-cardia gastric cancer

Type: Lauren classification
- diffuse: more often in young patients + worse prognosis
- intestinal: better differentiated under microscope
- mixed

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21
Q

What types of cancers can you get in the stomach?

A
  • adenocarcinoma (most common)
  • lymphoma
  • leiomyosarcoma
  • neuroendocrine tumours
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22
Q

Risk factors of gastric cancer

A
  • 50-70 years
  • male
  • pernicious anaemia
  • H-pylori
  • N- nitroso compound
  • family history
  • high salt
  • smoking
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23
Q

What is pernicious anaemia?

A

Autoimmune attack on parietal cells > less intrinsic factor

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24
Q

Presentation of gastric cancer

A
  • unexplained weight loss
  • epigastric abdominal pain
  • lymphadenopathy - Virchow’s node (enlargement of left supraclavicular node)
  • dysphagia (if cardia gastric cancer)
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25
What is Vichow’s node?
Enlargement of left supraclavicular node
26
Investigations of gastric cancer
- **bloods**: anaemia - **upper GI endoscopy + biopsy**: for tissue diagnosis - **CT chest, abdomen + pelvis**: for staging
27
Management of gastric cancer
- **superficial**: endoscopic mucosal resection - **localised**: gastrectomy or chemo radiation (if not suitable for surgery) - **advanced/metastatic**: chemotherapy/immunotherapy + support care
28
What is the most common type of pancreatic cancer?
Pancreatic ductal adenocarcinoma
29
What is an insulinoma?
Tumour which secretes insulin
30
Risk factors of pancreatic cancer
- smoking - chronic pancreatitis - inherited mutations in BRCA1, BRCA2 + PALB2 - male - increasing age
31
Presentation of pancreatic cancer
- painless jaundice - unexplained weight loss - abdominal/back pain - new onset type 2 diabetes mellitus over 50 years old without obesity related risk factors
32
Investigations of pancreatic cancer
- **bloods**: LFTS, CA 19-9 - **CT**: diagnosis + planning treatment - **USS**: for head of pancreas but not body or tail - **biopsy**
33
What is a tumour marker for pancreatic cancer?
CA 19-9
34
Management for pancreatic cancer
- surgical resection, followed by pancreatic enzyme replacement - biliary stenting for jaundice - chemotherapy - symptom management
35
What is hepatocelllar carcinoma?
Primary cancer arising from hepatocytes
36
Patients with hepatocellular carcinoma usually have a background of what?
Cirrhosis
37
Risk factors for hepatocellular carinoma
Causes of cirrhosis *e.g. alcohol, hep B+C*
38
Presentation of hepatocellular carcinoma
- most HCC occurs in patients with underlying liver disease which can mask the malignancy *e.g. fatigue, ascites* - new right upper quadrant pain - worsened jaundice
39
Investigations of hepatocellular carcinoma
- **bloods**: LFTs, prothrombin time/INR, viral hepatitis panel - **USS** - **CT/MRI abdomen** - **liver biopsy**
40
Treatment of hepatocellular carcinoma
- if suitable: surgery, resection or transplant - if not suitable: chemotherapy/immunotherapy to slow tumour growth
41
What is cholangiocarinoma?
Bile duct cancer
42
Most common type of cholagiocarcinoma?
Adenocarcinoma
43
Risk factors of cholangiocarioma
- liver + bile duct disease *e.g. cirrhosis, alcohol liver disease, gall stones, primary sclerosing cholagntitis* - infections - high alcohol consumption - exposure to toxins/meds
44
Presentation of cholangiocarcinomas
- painless jaundice - Pruritus (itch) - dark urine - light stool
45
Risk factors for colorectal cancer
- high red meat consumption - low dietary fibre - high alcohol intake + smoking - history of inflammatory bowel disease - familial adenomatous polyposis - hereditary nonpolyposis colorectal cancer - family history of bowel cancer
46
Presentation of colorectal cancer
- blood in stool - altered bowel habits - bowel obstruction or perforation - abdominal pain - ascites
47
Red flags in colorectal cancer
- blood in stool/rectal bleedin - change in bowel habit *e.g. overflow diarrhoea* - iron deficiency anaemia - unexplained weight loss - tenesmus -mass on rectal examination
48
What is tenesmus?
Feeling of incomplete excretion
49
What is overflow diarrhoea?
Changes between constipation and diarrhoea
50
What is occult bleeding?
Blood is stool that is visible to the naked eye
51
Compare right and left sided colon cancer
_Right_: - occult bleeding - bowel obstruction less likely - mass in right iliac fossa - more advanced at presentation - late change in bowel habits - fungating _Left_: - rectal bleeding - bowel obstruction more likely - mass in left iliac fossa - less advanced at presentation - early change in bowel habits - stenosing
52
Investigations of colorectal cancer
- **stool tests**: FIT - **blood test**: anaemia - **colonoscopy + biopsy** - **CT/MRI**
53
Management of colorectal cancer
- surgery with pre/post op chemotherapy/immunotherapy - chemotherapy/immunotherapy if not suitable for surgical intervention
54
What type of cancer is anal cancer most commonly?
Squamous cell carcinoma
55
Risk factors of anal cancer
- HPV 16 infection - HIV infection - anal sexual intercoyrse - chronic local inflammation due to Crohn’s or recurrent anal fissure
56
Presentation of anal cancer
- Perianal Pruritus or pain - bleeding - discharge - mass like sensation
57
Outline GI cancer staging
**TMN staging** T - size of primary tumour N - extent of regional lymph node involvement M - metastatic spread
58
Staging of colorectal cancer
**_Dukes’ staging_** - **Dukes’ A**: inner lining of bowel - **Dukes’ B**: spread into muscle layer - **Dukes’ C**: spread to at least 1 nearby lymph node - **Dukes’ D**: spread to another part of body
59
What is Dukes’ staging used for?
Colorectal cancer
60
Cancers arising in what part of the pancreas can result in the patient becoming jaundice?
**Head** Blocks common bile duct
61
Where in the colon would a cancer most likely result in a patient presenting with a bowel obstruction?
Sigmoid colon
62
Where can you get squamous cell carcinomas in the GI tract?
Oesophagus Anal canal distal to pectinate line
63
What is the assocaited tumour marker of pancreatic cancer?
CA 19-9
64
What is the tumour marker for colorectal cancer?
CEA
65
What are the tumour markers for the following: - pancreatic cancer - ovarian cancer - breast cancer - prostate carcinoma - hepatocellular, teratoma - colorectal cancer
- **pancreatic cancer**: CA 19-9 - **ovarian cancer**: CA 125 - **breast cancer**: CA 15-3 - **prostate carcinoma**: PSA - **hepatocellular, teratoma**: AFP - **colorectal cancer**: CEA
66
What is the tumour marker for hepatocellular cancer?
AFP

Gastrointestinal (30 decks)

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