GI Cancers Flashcards
What is a carcinoma?
Malignancy of the cells that make up the epithelial lining of skin or organs
What is an adenocarinoma?
Malignancy of glandular cells in epithelial tissue
What is an adenoma?
Benign tumour formed from glandular structures in epithelial tissues
What is the cancer with the highest prevalence in the UK?
Breast/prostate
What is the GI cancer with the highest prevalence??
Large bowel
What is the GI cancer with the lowest prevalence?
Liver
What are some common non specific signs of GI cancer?
Abdominal pain
Dysphagia
Weight loss
Blood in stools
Constipation
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.
Oesophageal cancer
What is odynophagia?
Painful swallowing
What is the most common cause of oesophageal cancer histologically in the upper 2/3s of the Oesophagus?
Squamous cell carcinoma
What is the most common cause of Oesophageal cancer of the lower 1/3 histologically?
Oovu java version
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
What is the most common cause of Oesophageal cancer of the lower 1/3 histologically?
Adenocarinomas from columnar epithelia
Barretts oesophagus
What are the clinical signs of Oesophageal cancer?
Progressive Dysphagia
Initially solids more difficult t swallow than fluids, eventually hard to swallow liquids
Odynophagia
Unexplained weight loss
What is the main red flag symptom for oesophageal cancer?
Progressive Dysphagia
What is the acronym used to remember red flags for oesophageal cancer?
ALARM
What are the red flag symptoms for oesophageal cancer?
ALARM
Anaemia (GI cancers often ulcerate)
Loss of weight
Anorexia
Recent onset of progressive symptoms
Malaena or masses
What is malaena?
Black tarry stool due to an upper GI bleed
What are the risk factors of oesophageal cancer?
SCC = smoking, alcohol use and dietary (hot beverages)
Adenocarnioma = obesity, reflux disease, Barretts oesophagus
What is the prognosis of survival after being diagnosed with oesophageal cancer?
5% survival at 5yrs
What investigations should be done if suspecting oesophageal cancer?
FBC (Anaemia)
Oesophagogastroduodenoscopy with biopsy
CT thorax and abdomen to stage
What treatment is done for oesophageal cancer?
Endoscopic therapies (for early stage)
Oesphagectomy (removal of oesophagus
Chemoradiotherapy
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
Gastric cancer
What is occult blood?
Blood that is not visible to the naked eye in the stool
What is the most common cause of gastric cancer histologically?
Adenocarcinomas
What are the most common locations for adenocarcinomas in gastric cancer to occur?
Cardia
Antrum
Body of stomach
How does gastric cancer of the cardia present?
Similar to oesophageal cancer (Dysphagia)
How does non cardia Gastric cancer present?
Vomiting due to cancer restricting the stomach contents entering the duodenum
What is the Lauren classification for gastric cancers??
Diffuse = poorly differentiated
Intestinal = better differentiation so has better prognosis
What are some strong risks of developing gastric cancer?
Pernicious anemia
H-pylori
N-nitroso compounds
How does pernicious anemia increase risk of gastric cancer?
Immune response to parietal cells leading to les intrinsic factor being produced
What foods are high n-nitroso compounds?
Processed foods
What are the most common signs or symptoms for developing gastric cancer?
Weight loss
Epigastric abdominal pain
Lymphadenopathy of VIRCHOWS node
Dysphagia (if located around the cardia)
Where is VIRCHOWS node located?
Left supraclavicular fossa
What is the prognosis for gastric cancer with local disease and metastasis?
Local = 70% 5 year survival
Metastasis = 5%
What investigations are done for gastric cancer?
Bloods (anaemia)
Upper GI endoscopy and biopsy for diagnosis
CT (Chest, abdomen and pelvis) for staging
How is Gastric cancer managed?
Superficial gastric caner = endoscopic mucosal resection
Localised = gastrectomy or Chemo
Advanced/metastatic = chemotherapy/immunotherapy and supportive care
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
Pancreatic cancer
What is the main histological type of pancreatic cancer?
Pancreatic duct all (exocrine) adenocarinoma
What is special about pancreatic neuroendocrine tumours?
Can be functional so can produce hormones like insulin (insulinoma)
What are the risk factors for pancreatic cancer?
Smoking
Chronic pancreatitis
Inherited mutations in BRCA1, BRCA2 and PALB2 and familial syndromes
Men
Old
What are the risk factors for pancreatic cancer?
Smoking
Chronic pancreatitis
Inherited mutations in BRCA1, BRCA2 and PALB2 and familial syndromes
Men
Old
What are the red flag presentations of pancreatic cancer?
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
When does painless jaundice occur with pancreatic cancer?
The tumour needs to grow at the head of the pancreas to block the bile duct
What investigations are done if pancreatic cancer is suspected?
Bloods (LFT if jaundice, CA 19-9)
CT
Ultrasound for (head of pancreas cancer, not very accurate for body or tail)
Biopsy
What is the tumour marker for Pancreatic cancer?
CA 19-9
What is the management for pancreatic cancer?
Surgical resection (needs insulin therapy and pancreatic enzyme replacement)
Biliary stenting if jaundiced
Chemo, radio and symptom management
What is hepatocellular carcinoma
Where the primary cancer arises from hepatocytes (Usually with a background of cirrhosis)
What are the risk factors of hepatocellular carcinoma?
Cirrhosis
(Often due to alcohol and Hepatitis B and C infections)
What is the clinical
presentation for hepatocellular carcinoma?
Worsened ascites and fatigue (since most HCC occurs in patients with liver disease like cirrhosis)
Painful palpation of RUQ
What is the prognosis for hepatocellular carcinoma with completed surgical resection or liver transplant?
Advanced HCC?
50% 5 year survival with complete resection
Advanced = 1yr median survival
What investigations are done on a patient with suspected hepatocellular carcinoma?
Bloods:
-LFTs
-Prothrobin time/INR (check synthetic liver function)
-viral hepatitis panel
Ultrasound (can screen high risk individuals)
CT/MRI abdomen (staging)
Liver biopsy
What is the treatments for hepatocellular carcinoma?
Resection, transplantation or ablation (using very hot or cold to remove tumour)
Chemo/immunotherapy if surgery not suitable
Why are liver cancers most commonly metastases and not the primary site?
Many structures drain into the liver via the portal vein (haematological spread)
Lymphatic spread
Ovarian cancer can spread via transcoelomic spread
How can ovarian cancer metastasise too the liver?
Fimbriae open to peritoneal cavity so can spread transcoelomically to the liver
What are the 3 main veins forming the portal vein?
Splenic vein
Superior mesenteric vein
Inferior mesenteric vein
What is a cholangiocarnioma?
Cancer of the bile duct
What are most of chloangiocarinomas histologically?
Adenocarcinoma
What is meant by a cholangiocarcinoma being intrahepatic or extrahepatic?
Intrahepatic = bile ducts in liver
Extrahepatic = bile duct outside liver
What are the risk factors for development of chlangiocarcinoma?
Liver and bileduct disease:
-cirrhosis
-alcoholic liver disease
-gallstones
-Primary Sclerosing Cholangitis
Infections
High alchol consumption
Exposures to certain toxins/meds
What are the red flag clinical signs for cholangiocarinoma?
PAINLESS JAUNDICE (Obstruction of biliary system)
Pruritus
Dark urine and light colour stool in extrahepatic due to biliary obstruction
Why is urine dark and stool light if the biliary tree is obstructed?
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
What is the prognosis for cholangiocarcinoma?
2% survival over 5yrs with metastatic disease
How is cholangiocarcinoma treated?
Surgical and non surgical
How do colorectal cancers often present histologically?
Adenocarcinomas which have progressed/developed from normal epithelium in a classical pattern
What are the risk factors for colorectal cancer?
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)
What is the alternate name for hereditary nonpolyposis colorectal cancer (HNPCC)?
Lynch syndrome
What are the red flag clinical presentations for colorectal cancer?
Blood in stool
Altered bowel habits
Bowel obstruction
Perforation or symptoms due to hepatic or peritoneala metastases
What is the prognosis for colorectal cancer?
5yr survival rate for non metastatic = 50% - 95%
What are the red flag symptoms/signs for colorectal cancer?
Blood in stool/rectal bleeding
Change in bowel habit
Iron deficiency anaemia
Unexplained weight loss
Tenesmus
Mass on rectal exam
Alternating constipation + watery diarrhoea
What is tenesmus?
Still the urge to go to the toilet after clearing bowels
Why is it important to determine what type of blood is in the stool?
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
What can cause overflow diarrhoea in colorectal cancer?
Solid stool stuck behind Tumor
Liquid stool builds up behind the tumour
Pressure builds up high enough till the watery stool is pushed through
What is considered right sided colon cancer?
Ascending colon
What is considered left sided colon cancer?
Descending and sigmoid colon
What is the difference in type of bleeding in colorectal cancer that is right sided or left sided?
Right sided = occult bleeding
Left sided = rectal bleeding
What is occult bleeding?
Why is it more commonly seen in right sided colon cancer and not left?
When blood in the stool is not visible to the naked eye
Since the blood has more time to be processed
Why is the bowel more likely to be obstructed in right sided colon cancer than left?
The ascending colon has a narrower lumen than the descending and sigmoid colon
Where is a mass palpable in right sided colon cancer and left sided colon cancer?
Right = right iliac fossa
Left = left iliac fossa
How do the types of lesions differ in right sided and left sided colorectal cancer?
Right sided = fungating lesions
Left sided = stenosing lesions
What is meant by a fungating lesion?
Lesion that causes ulceration
What is meant by a stenosing lesion?
Leads to fibrosis and stricture formation
Look at the last slide at image 1:
What is the sign called?
What is it indicative of?
Apple core sign
Colorectal tumour narrowing bowel
What is the change in cell type that occurs in the adeno-Carcinoma sequence for colorectal cancer?
Normal glandular epithelium -> adenoma (benign neoplasm) -> invasive carcinoma
What genes are turned off and on in the series of genetic mutations that cause the adenoma-carcinoma sequence?
Oncogenes activated
Tumour suppressor genes inactivated
What is an example of a Tumour suppressor gene?
p53
What investigations are done for colorectal cancer?
Stool test (recall immunochemical test)
Bloods (anemia CEA)
Colonoscopy
CT, MRI
What is the tumour marker for colorectal cancer?
CEA
How is colorectal cancer managed?
Surgery with pre or post op chemo/immunotherapy
Chemo/immunotherapy if not for surgery
What age is bowel cancer screening done between?
60-74
Testing for blood in faeces
What is the main histological cause of anal cancer?
Squamous cell carcinoma
What are the risk factors for developing anal cancer?
HPV infection
HPV-16
HIV infection
Anal receptive intercourse (inc risk of HPV)
Chronically local inflammation due to IBD or recurrent anal fissures
How does anal cancer present?
Perianal Pruritus
Perianal pain
Bleeding
Discharge
Mass like sensation
What is the prognosis for anal cancer?
70% cured with chemo
HPV smears and better prevention of HIV infection will lower incidence
How are GI cancers staged?
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
What is Dukes staging system?
Staging of colorectal cancer
How is colorectal cancer staged using dukes staging system?
A = confined in bowel wall
B= through mucosal wall
C = spread to a lymph node
D = metastasised to another organ
Go to the last slide:
What pathology is visible?
Barrett’s oesophagus
