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Gastrointestinal > GI Cancers > Flashcards

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

Investigations of oesophageal cancers

A
  • blood tests: anaemia
  • oesophagogastroduodenoscopy with biopsy: can determine is benign or malignant
  • CT thorax + abdomen: size, local invasion, metastatic spread
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11
Q

Treatment of oesophageal cancer

A
  • endoscopic therapies
  • oesophagectomy
  • chemoradiotherapy
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12
Q

What is the most common GI cancer?

A

Large bowel

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13
Q

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

A

Increased risk of dysplasia

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14
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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15
Q

What is odynophagia?

A

Pain on swallowing

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16
Q

What type of cancer is most common in gastric cancer?

A

Adenocarcinoma

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17
Q

Where is gastric cancer most commonly found in order?

A

Cardia
Antrum
Body
CAB

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18
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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19
Q

What types of cancers can you get in the stomach?

A
  • adenocarcinoma (most common)
  • lymphoma
  • leiomyosarcoma
  • neuroendocrine tumours
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20
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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21
Q

What is pernicious anaemia?

A

Autoimmune attack on parietal cells > less intrinsic factor

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22
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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23
Q

What is Vichow’s node?

A

Enlargement of left supraclavicular node

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24
Q

Investigations of gastric cancer

A
  • bloods: anaemia
  • upper GI endoscopy + biopsy: for tissue diagnosis
  • CT chest, abdomen + pelvis: for staging
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25
Q

Management of gastric cancer

A
  • superficial: endoscopic mucosal resection
  • localised: gastrectomy or chemo radiation (if not suitable for surgery)
  • advanced/metastatic: chemotherapy/immunotherapy + support care
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26
Q

What is the most common type of pancreatic cancer?

A

Pancreatic ductal adenocarcinoma

27
Q

What is an insulinoma?

A

Tumour which secretes insulin

28
Q

Risk factors of pancreatic cancer

A
  • smoking
  • chronic pancreatitis
  • inherited mutations in BRCA1, BRCA2 + PALB2
  • male
  • increasing age
29
Q

Presentation of pancreatic cancer

A
  • painless jaundice
  • unexplained weight loss
  • abdominal/back pain
  • new onset type 2 diabetes mellitus over 50 years old without obesity related risk factors
30
Q

Investigations of pancreatic cancer

A
  • bloods: LFTS, CA 19-9
  • CT: diagnosis + planning treatment
  • USS: for head of pancreas but not body or tail
  • biopsy
31
Q

What is a tumour marker for pancreatic cancer?

A

CA 19-9

32
Q

Management for pancreatic cancer

A
  • surgical resection, followed by pancreatic enzyme replacement
  • biliary stenting for jaundice
  • chemotherapy
  • symptom management
33
Q

What is hepatocelllar carcinoma?

A

Primary cancer arising from hepatocytes

34
Q

Patients with hepatocellular carcinoma usually have a background of what?

A

Cirrhosis

35
Q

Risk factors for hepatocellular carinoma

A

Causes of cirrhosis
e.g. alcohol, hep B+C

36
Q

Presentation of hepatocellular carcinoma

A
  • 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
37
Q

Investigations of hepatocellular carcinoma

A
  • bloods: LFTs, prothrombin time/INR, viral hepatitis panel
  • USS
  • CT/MRI abdomen
  • liver biopsy
38
Q

Treatment of hepatocellular carcinoma

A
  • if suitable: surgery, resection or transplant
  • if not suitable: chemotherapy/immunotherapy to slow tumour growth
39
Q

What is cholangiocarinoma?

A

Bile duct cancer

40
Q

Most common type of cholagiocarcinoma?

A

Adenocarcinoma

41
Q

Risk factors of cholangiocarioma

A
  • liver + bile duct disease e.g. cirrhosis, alcohol liver disease, gall stones, primary sclerosing cholagntitis
  • infections
  • high alcohol consumption
  • exposure to toxins/meds
42
Q

Presentation of cholangiocarcinomas

A
  • painless jaundice
  • Pruritus (itch)
  • dark urine
  • light stool
43
Q

Risk factors for colorectal cancer

A
  • high dietary fat
  • high red meat consumption
  • low dietary fibre
  • high alcohol intake
  • history of inflammatory bowel disease
  • familial adenoma tours polyposis
  • hereditary nonpolyposis colorectal cancer
44
Q

Presentation of colorectal cancer

A
  • blood in stool
  • altered bowel habits
  • bowel obstruction or perforation
  • abdominal pain
  • ascites
45
Q

Red flags in colorectal cancer

A
  • blood in stool/rectal bleedin
  • change in bowel habit e.g. overflow diarrhoea
  • iron deficiency anaemia
  • unexplained weight loss
  • tenesmus
    -mass on rectal examination
46
Q

What is tenesmus?

A

Feeling of incomplete excretion

47
Q

What is overflow diarrhoea?

A

Changes between constipation and diarrhoea

48
Q

What is occult bleeding?

A

Blood is stool that is visible to the naked eye

49
Q

Compare right and left sided colon cancer

A

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

50
Q

Investigations of colorectal cancer

A
  • stool tests: FIT
  • blood test: anaemia
  • colonoscopy + biopsy
  • CT/MRI
51
Q

Management of colorectal cancer

A
  • surgery with pre/post op chemotherapy/immunotherapy
  • chemotherapy/immunotherapy if not suitable for surgical intervention
52
Q

What type of cancer is anal cancer most commonly?

A

Squamous cell carcinoma

53
Q

Risk factors of anal cancer

A
  • HPV 16 infection
  • HIV infection
  • anal sexual intercoyrse
  • chronic local inflammation due to Crohn’s or recurrent anal fissure
54
Q

Presentation of anal cancer

A
  • Perianal Pruritus or pain
  • bleeding
  • discharge
  • mass like sensation
55
Q

Outline GI cancer staging

A

TMN staging
T - size of primary tumour
N - extent of regional lymph node involvement
M - metastatic spread

56
Q

Staging of colorectal cancer

A

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

57
Q

What is Dukes’ staging used for?

A

Colorectal cancer

58
Q

Cancers arising in what part of the pancreas can result in the patient becoming jaundice?

A

Head
Blocks common bile duct

59
Q

Where in the colon would a cancer most likely result in a patient presenting with a bowel obstruction?

A

Sigmoid colon

60
Q

Where can you get squamous cell carcinomas in the GI tract?

A

Oesophagus
Anal canal distal to pectinate line

61
Q

What is the assocaited tumour marker of pancreatic cancer?

A

CA 19-9

62
Q

What is the tumour marker for colorectal cancer?

A

CEA

63
Q

What are the tumour markers for the following:
- pancreatic cancer
- ovarian cancer
- breast cancer
- prostate carcinoma
- hepatocellular, teratoma
- colorectal cancer

A
  • pancreatic cancer: CA 19-9
  • ovarian cancer: CA 125
  • breast cancer: CA 15-3
  • prostate carcinoma: PSA
  • hepatocellular, teratoma: AFP
  • colorectal cancer: CEA
64
Q

What is the tumour marker for hepatocellular cancer?

A

AFP

Gastrointestinal (28 decks)

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