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GI > GI Cancers > Flashcards

GI Cancers Flashcards

1
Q

What is a carcinoma?

A

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

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2
Q

What is an adenocarinoma?

A

Malignancy of glandular cells in epithelial tissue

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3
Q

What is an adenoma?

A

Benign tumour formed from glandular structures in epithelial tissues

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4
Q

What is the cancer with the highest prevalence in the UK?

A

Breast/prostate

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5
Q

What is the GI cancer with the highest prevalence??

A

Large bowel

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6
Q

What is the GI cancer with the lowest prevalence?

A

Liver

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7
Q

What are some common non specific signs of GI cancer?

A

Abdominal pain
Dysphagia
Weight loss
Blood in stools
Constipation

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8
Q

What GI cancer is likely with this presentation?

55yr old man presents with severe Dysphagia to solids and worsening Dysphagia to liquids. 40 pack yr smoking and a 6 pack of beer per day. Lost over 10% body weight and is currently nourished by milkshakes. Has mild odynophagia and is constantly coughing up mucus.

A

Oesophageal cancer

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9
Q

What is odynophagia?

A

Painful swallowing

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10
Q

What is the most common cause of oesophageal cancer histologically in the upper 2/3s of the Oesophagus?

A

Squamous cell carcinoma

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11
Q

What is the most common cause of Oesophageal cancer of the lower 1/3 histologically?
Oovu java version

A

Sucking dick (everyone’s apart from cal)
Your mum
Dawn Donoher
Smoking
Vomiting from Cals sperm eww
Cals sperm tastes like vomit
Its putrid
Smell all funky go get checked
Being daisy
Pots
Cups
Plates
Cals stupid attitude
Fuck cal
Stupid ass hoe
Imagine being ugly

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12
Q

What is the most common cause of Oesophageal cancer of the lower 1/3 histologically?

A

Adenocarinomas from columnar epithelia

Barretts oesophagus

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13
Q

What are the clinical signs of Oesophageal cancer?

A

Progressive Dysphagia

Initially solids more difficult t swallow than fluids, eventually hard to swallow liquids

Odynophagia
Unexplained weight loss

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14
Q

What is the main red flag symptom for oesophageal cancer?

A

Progressive Dysphagia

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15
Q

What is the acronym used to remember red flags for oesophageal cancer?

A

ALARM

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16
Q

What are the red flag symptoms for oesophageal cancer?

A

ALARM

Anaemia (GI cancers often ulcerate)
Loss of weight
Anorexia
Recent onset of progressive symptoms
Malaena or masses

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17
Q

What is malaena?

A

Black tarry stool due to an upper GI bleed

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18
Q

What are the risk factors of oesophageal cancer?

A

SCC = smoking, alcohol use and dietary (hot beverages)

Adenocarnioma = obesity, reflux disease, Barretts oesophagus

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19
Q

What is the prognosis of survival after being diagnosed with oesophageal cancer?

A

5% survival at 5yrs

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20
Q

What investigations should be done if suspecting oesophageal cancer?

A

FBC (Anaemia)
Oesophagogastroduodenoscopy with biopsy

CT thorax and abdomen to stage

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21
Q

What treatment is done for oesophageal cancer?

A

Endoscopic therapies (for early stage)
Oesphagectomy (removal of oesophagus
Chemoradiotherapy

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22
Q

What type of cancer is this patient likely to have?

77yr old
Weight loss of 6.8kg and 3month of Dysphagia and abdominal pain
Stools positive for occult blood

A

Gastric cancer

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23
Q

What is occult blood?

A

Blood that is not visible to the naked eye in the stool

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24
Q

What is the most common cause of gastric cancer histologically?

A

Adenocarcinomas

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25
Q

What are the most common locations for adenocarcinomas in gastric cancer to occur?

A

Cardia
Antrum
Body of stomach

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26
Q

How does gastric cancer of the cardia present?

A

Similar to oesophageal cancer (Dysphagia)

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27
Q

How does non cardia Gastric cancer present?

A

Vomiting due to cancer restricting the stomach contents entering the duodenum

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28
Q

What is the Lauren classification for gastric cancers??

A

Diffuse = poorly differentiated

Intestinal = better differentiation so has better prognosis

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29
Q

What are some strong risks of developing gastric cancer?

A

Pernicious anemia
H-pylori
N-nitroso compounds

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30
Q

How does pernicious anemia increase risk of gastric cancer?

A

Immune response to parietal cells leading to les intrinsic factor being produced

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31
Q

What foods are high n-nitroso compounds?

A

Processed foods

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32
Q

What are the most common signs or symptoms for developing gastric cancer?

A

Weight loss
Epigastric abdominal pain
Lymphadenopathy of VIRCHOWS node
Dysphagia (if located around the cardia)

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33
Q

Where is VIRCHOWS node located?

A

Left supraclavicular fossa

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34
Q

What is the prognosis for gastric cancer with local disease and metastasis?

A

Local = 70% 5 year survival

Metastasis = 5%

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35
Q

What investigations are done for gastric cancer?

A

Bloods (anaemia)
Upper GI endoscopy and biopsy for diagnosis
CT (Chest, abdomen and pelvis) for staging

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36
Q

How is Gastric cancer managed?

A

Superficial gastric caner = endoscopic mucosal resection

Localised = gastrectomy or Chemo

Advanced/metastatic = chemotherapy/immunotherapy and supportive care

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37
Q

What GI cancer is this patient likely to have?

45yr woman
Vague Epigastric pain
Treatment PPI, analgesia and antacids ineffective
Experiencing back pain
Pancreatic mass with liver metastases

A

Pancreatic cancer

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38
Q

What is the main histological type of pancreatic cancer?

A

Pancreatic duct all (exocrine) adenocarinoma

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39
Q

What is special about pancreatic neuroendocrine tumours?

A

Can be functional so can produce hormones like insulin (insulinoma)

40
Q

What are the risk factors for pancreatic cancer?

A

Smoking
Chronic pancreatitis
Inherited mutations in BRCA1, BRCA2 and PALB2 and familial syndromes

Men
Old

41
Q

What are the risk factors for pancreatic cancer?

A

Smoking
Chronic pancreatitis
Inherited mutations in BRCA1, BRCA2 and PALB2 and familial syndromes

Men
Old

42
Q

What are the red flag presentations of pancreatic cancer?

A

Painless jaundice
Unexplained weight loss
Can present with abdominal/back pain

New onset type 2 DM in someone over 50 without any obesity related risk factors

43
Q

When does painless jaundice occur with pancreatic cancer?

A

The tumour needs to grow at the head of the pancreas to block the bile duct

44
Q

What investigations are done if pancreatic cancer is suspected?

A

Bloods (LFT if jaundice, CA 19-9)

CT
Ultrasound for (head of pancreas cancer, not very accurate for body or tail)

Biopsy

45
Q

What is the tumour marker for Pancreatic cancer?

A

CA 19-9

46
Q

What is the management for pancreatic cancer?

A

Surgical resection (needs insulin therapy and pancreatic enzyme replacement)

Biliary stenting if jaundiced

Chemo, radio and symptom management

47
Q

What is hepatocellular carcinoma

A

Where the primary cancer arises from hepatocytes (Usually with a background of cirrhosis)

48
Q

What are the risk factors of hepatocellular carcinoma?

A

Cirrhosis
(Often due to alcohol and Hepatitis B and C infections)

49
Q

What is the clinical
presentation for hepatocellular carcinoma?

A

Worsened ascites and fatigue (since most HCC occurs in patients with liver disease like cirrhosis)

Painful palpation of RUQ

50
Q

What is the prognosis for hepatocellular carcinoma with completed surgical resection or liver transplant?

Advanced HCC?

A

50% 5 year survival with complete resection

Advanced = 1yr median survival

51
Q

What investigations are done on a patient with suspected hepatocellular carcinoma?

A

Bloods:
-LFTs
-Prothrobin time/INR (check synthetic liver function)
-viral hepatitis panel

Ultrasound (can screen high risk individuals)
CT/MRI abdomen (staging)
Liver biopsy

52
Q

What is the treatments for hepatocellular carcinoma?

A

Resection, transplantation or ablation (using very hot or cold to remove tumour)

Chemo/immunotherapy if surgery not suitable

53
Q

Why are liver cancers most commonly metastases and not the primary site?

A

Many structures drain into the liver via the portal vein (haematological spread)

Lymphatic spread

Ovarian cancer can spread via transcoelomic spread

54
Q

How can ovarian cancer metastasise too the liver?

A

Fimbriae open to peritoneal cavity so can spread transcoelomically to the liver

55
Q

What are the 3 main veins forming the portal vein?

A

Splenic vein
Superior mesenteric vein
Inferior mesenteric vein

56
Q

What is a cholangiocarnioma?

A

Cancer of the bile duct

57
Q

What are most of chloangiocarinomas histologically?

A

Adenocarcinoma

58
Q

What is meant by a cholangiocarcinoma being intrahepatic or extrahepatic?

A

Intrahepatic = bile ducts in liver

Extrahepatic = bile duct outside liver

59
Q

What are the risk factors for development of chlangiocarcinoma?

A

Liver and bileduct disease:
-cirrhosis
-alcoholic liver disease
-gallstones
-Primary Sclerosing Cholangitis

Infections
High alchol consumption
Exposures to certain toxins/meds

60
Q

What are the red flag clinical signs for cholangiocarinoma?

A

PAINLESS JAUNDICE (Obstruction of biliary system)
Pruritus
Dark urine and light colour stool in extrahepatic due to biliary obstruction

61
Q

Why is urine dark and stool light if the biliary tree is obstructed?

A

Liver still able to conjugated bilirubin
This makes it water soluble
So lots of conjugated bilirubin gets absorbed back into the blood
Since the conjugated bilirubin is water soluble it can be filtered by the kidney lots of conjugate bilirubin ends up in the urine which makes it dark

62
Q

What is the prognosis for cholangiocarcinoma?

A

2% survival over 5yrs with metastatic disease

63
Q

How is cholangiocarcinoma treated?

A

Surgical and non surgical

64
Q

How do colorectal cancers often present histologically?

A

Adenocarcinomas which have progressed/developed from normal epithelium in a classical pattern

65
Q

What are the risk factors for colorectal cancer?

A

Diet:
-high fat
-red meat consumption
-low fibre
-high alcohol intake

IBD (chronic inflammation inc cancer risk)

Genetic conditions:
-Familial adenomatous polyposis (FAP)
-Hereditary nonpolyposis colorectal cancer (HNPCC)

66
Q

What is the alternate name for hereditary nonpolyposis colorectal cancer (HNPCC)?

A

Lynch syndrome

67
Q

What are the red flag clinical presentations for colorectal cancer?

A

Blood in stool
Altered bowel habits

Bowel obstruction
Perforation or symptoms due to hepatic or peritoneala metastases

68
Q

What is the prognosis for colorectal cancer?

A

5yr survival rate for non metastatic = 50% - 95%

69
Q

What are the red flag symptoms/signs for colorectal cancer?

A

Blood in stool/rectal bleeding

Change in bowel habit

Iron deficiency anaemia
Unexplained weight loss
Tenesmus
Mass on rectal exam

Alternating constipation + watery diarrhoea

70
Q

What is tenesmus?

A

Still the urge to go to the toilet after clearing bowels

71
Q

Why is it important to determine what type of blood is in the stool?

A

Fresh red blood (on tissue) = likely anal fissure or haemorrhage

Blood mixed in stool = cancer/pathology more proximal in rectum

Malaena = Upper GI tract bleed

72
Q

What can cause overflow diarrhoea in colorectal cancer?

A

Solid stool stuck behind Tumor
Liquid stool builds up behind the tumour
Pressure builds up high enough till the watery stool is pushed through

73
Q

What is considered right sided colon cancer?

A

Ascending colon

74
Q

What is considered left sided colon cancer?

A

Descending and sigmoid colon

75
Q

What is the difference in type of bleeding in colorectal cancer that is right sided or left sided?

A

Right sided = occult bleeding

Left sided = rectal bleeding

76
Q

What is occult bleeding?

Why is it more commonly seen in right sided colon cancer and not left?

A

When blood in the stool is not visible to the naked eye

Since the blood has more time to be processed

77
Q

Why is the bowel more likely to be obstructed in right sided colon cancer than left?

A

The ascending colon has a narrower lumen than the descending and sigmoid colon

78
Q

Where is a mass palpable in right sided colon cancer and left sided colon cancer?

A

Right = right iliac fossa

Left = left iliac fossa

79
Q

How do the types of lesions differ in right sided and left sided colorectal cancer?

A

Right sided = fungating lesions

Left sided = stenosing lesions

80
Q

What is meant by a fungating lesion?

A

Lesion that causes ulceration

81
Q

What is meant by a stenosing lesion?

A

Leads to fibrosis and stricture formation

82
Q

Look at the last slide at image 1:

What is the sign called?
What is it indicative of?

A

Apple core sign

Colorectal tumour narrowing bowel

83
Q

What is the change in cell type that occurs in the adeno-Carcinoma sequence for colorectal cancer?

A

Normal glandular epithelium -> adenoma (benign neoplasm) -> invasive carcinoma

84
Q

What genes are turned off and on in the series of genetic mutations that cause the adenoma-carcinoma sequence?

A

Oncogenes activated

Tumour suppressor genes inactivated

85
Q

What is an example of a Tumour suppressor gene?

A

p53

86
Q

What investigations are done for colorectal cancer?

A

Stool test (recall immunochemical test)

Bloods (anemia CEA)
Colonoscopy
CT, MRI

87
Q

What is the tumour marker for colorectal cancer?

A

CEA

88
Q

How is colorectal cancer managed?

A

Surgery with pre or post op chemo/immunotherapy

Chemo/immunotherapy if not for surgery

89
Q

What age is bowel cancer screening done between?

A

60-74

Testing for blood in faeces

90
Q

What is the main histological cause of anal cancer?

A

Squamous cell carcinoma

91
Q

What are the risk factors for developing anal cancer?

A

HPV infection
HPV-16

HIV infection
Anal receptive intercourse (inc risk of HPV)
Chronically local inflammation due to IBD or recurrent anal fissures

92
Q

How does anal cancer present?

A

Perianal Pruritus
Perianal pain
Bleeding
Discharge
Mass like sensation

93
Q

What is the prognosis for anal cancer?

A

70% cured with chemo

HPV smears and better prevention of HIV infection will lower incidence

94
Q

How are GI cancers staged?

A

TNM staging

T = primary Tumor size
N = extent of regional ymph node involvement
M = metastatic spread

Then converted to overall stage 1,2,3,4 4 = worst

95
Q

What is Dukes staging system?

A

Staging of colorectal cancer

96
Q

How is colorectal cancer staged using dukes staging system?

A

A = confined in bowel wall
B= through mucosal wall
C = spread to a lymph node
D = metastasised to another organ

97
Q

Go to the last slide:
What pathology is visible?

A

Barrett’s oesophagus

GI (35 decks)

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