GI Cancers Flashcards
Define carcinoma
Malignancy of cells that make up the epithelial lining of skin or tissue lining organs
Define adenocarcinoma
Malignancy of glandular cells in epithelial tissue
Define adenoma
Benign tumour formed from glandular structures in epithelial tissue
Order of incidence of GI cancers
- breast/prostate (not GI but most common generally)
- large bowel
- pancreas
- oesophagus
- stomach
- liver
What cancers generally impact the upper 2/3rd of the oesophagus?
Squamous cell carcinomas
What cancers generally effect the lower 1/3rd of the oesophagus?
Adenocarcinomas
e.g. Barrett’s oesophagus
Red flags of oesophageal cancer
- progressive dysphagia
ALARM - Anaemia
- unintentional weight Loss
- Anorexia
- Recent onset of progressive symptoms
- Malaena or palpable mass
Risk factors of oesophageal cancers (carcinomas)
Smoking
Alcohol use
Dietary intake e.g hot drinks
Risk factors of oesophageal cancers (adenocarcinoma)
Obesity
Reflux disease
Barrett’s oesophagus
Investigations of oesophageal cancers
- blood tests: anaemia
- oesophagogastroduodenoscopy with biopsy: can determine is benign or malignant
- CT thorax + abdomen: size, local invasion, metastatic spread
Treatment of oesophageal cancer
- endoscopic therapies
- oesophagectomy
- chemoradiotherapy
What is the most common GI cancer?
Large bowel
Why is there a risk of adenocarcinomas in a patient with Barrett’s oesophagus?
Increased risk of dysplasia
Presentation of oesophageal cancer
- progressive dysphagia
- initially are more difficult to swallow solids than fluids but with progression liquids become hard to swallow too
- odynophagia
- unexplained weight loss
What is odynophagia?
Pain on swallowing
What type of cancer is most common in gastric cancer?
Adenocarcinoma
Where is gastric cancer most commonly found in order?
Cardia
Antrum
Body
CAB
Classifications of gastric cancer
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
What types of cancers can you get in the stomach?
- adenocarcinoma (most common)
- lymphoma
- leiomyosarcoma
- neuroendocrine tumours
Risk factors of gastric cancer
- 50-70 years
- male
- pernicious anaemia
- H-pylori
- N- nitroso compound
- family history
- high salt
- smoking
What is pernicious anaemia?
Autoimmune attack on parietal cells > less intrinsic factor
Presentation of gastric cancer
- unexplained weight loss
- epigastric abdominal pain
- lymphadenopathy - Virchow’s node (enlargement of left supraclavicular node)
- dysphagia (if cardia gastric cancer)
What is Vichow’s node?
Enlargement of left supraclavicular node
Investigations of gastric cancer
- bloods: anaemia
- upper GI endoscopy + biopsy: for tissue diagnosis
- CT chest, abdomen + pelvis: for staging
Management of gastric cancer
- superficial: endoscopic mucosal resection
- localised: gastrectomy or chemo radiation (if not suitable for surgery)
- advanced/metastatic: chemotherapy/immunotherapy + support care
What is the most common type of pancreatic cancer?
Pancreatic ductal adenocarcinoma
What is an insulinoma?
Tumour which secretes insulin
Risk factors of pancreatic cancer
- smoking
- chronic pancreatitis
- inherited mutations in BRCA1, BRCA2 + PALB2
- male
- increasing age
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
Investigations of pancreatic cancer
- bloods: LFTS, CA 19-9
- CT: diagnosis + planning treatment
- USS: for head of pancreas but not body or tail
- biopsy
What is a tumour marker for pancreatic cancer?
CA 19-9
Management for pancreatic cancer
- surgical resection, followed by pancreatic enzyme replacement
- biliary stenting for jaundice
- chemotherapy
- symptom management
What is hepatocelllar carcinoma?
Primary cancer arising from hepatocytes
Patients with hepatocellular carcinoma usually have a background of what?
Cirrhosis
Risk factors for hepatocellular carinoma
Causes of cirrhosis
e.g. alcohol, hep B+C
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
Investigations of hepatocellular carcinoma
- bloods: LFTs, prothrombin time/INR, viral hepatitis panel
- USS
- CT/MRI abdomen
- liver biopsy
Treatment of hepatocellular carcinoma
- if suitable: surgery, resection or transplant
- if not suitable: chemotherapy/immunotherapy to slow tumour growth
What is cholangiocarinoma?
Bile duct cancer
Most common type of cholagiocarcinoma?
Adenocarcinoma
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
Presentation of cholangiocarcinomas
- painless jaundice
- Pruritus (itch)
- dark urine
- light stool
Risk factors for colorectal cancer
- 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
Presentation of colorectal cancer
- blood in stool
- altered bowel habits
- bowel obstruction or perforation
- abdominal pain
- ascites
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
What is tenesmus?
Feeling of incomplete excretion
What is overflow diarrhoea?
Changes between constipation and diarrhoea
What is occult bleeding?
Blood is stool that is visible to the naked eye
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
Investigations of colorectal cancer
- stool tests: FIT
- blood test: anaemia
- colonoscopy + biopsy
- CT/MRI
Management of colorectal cancer
- surgery with pre/post op chemotherapy/immunotherapy
- chemotherapy/immunotherapy if not suitable for surgical intervention
What type of cancer is anal cancer most commonly?
Squamous cell carcinoma
Risk factors of anal cancer
- HPV 16 infection
- HIV infection
- anal sexual intercoyrse
- chronic local inflammation due to Crohn’s or recurrent anal fissure
Presentation of anal cancer
- Perianal Pruritus or pain
- bleeding
- discharge
- mass like sensation
Outline GI cancer staging
TMN staging
T - size of primary tumour
N - extent of regional lymph node involvement
M - metastatic spread
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
What is Dukes’ staging used for?
Colorectal cancer
Cancers arising in what part of the pancreas can result in the patient becoming jaundice?
Head
Blocks common bile duct
Where in the colon would a cancer most likely result in a patient presenting with a bowel obstruction?
Sigmoid colon
Where can you get squamous cell carcinomas in the GI tract?
Oesophagus
Anal canal distal to pectinate line
What is the assocaited tumour marker of pancreatic cancer?
CA 19-9
What is the tumour marker for colorectal cancer?
CEA
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
What is the tumour marker for hepatocellular cancer?
AFP
