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Gastro > GI cancers > Flashcards

GI cancers Flashcards

1
Q

What is primary cancer?

A

Cancer arising directly from cells in an organ

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2
Q

What is secondary cancer?
aka metastasis

A

Cancer spread from another organ, directly or by other means (blood/lymph)

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3
Q

What are the two types of cells in epithelium
and their respective cancers ?

A

Squamous - SCC
Glandular - adenocarcinoma

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4
Q

What are cancers of enteroendocrine cells called?

A

Neuroendocrine Tumours (NETs)

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5
Q

What are cancers of smooth muscle called?

A

Leiomyosarcomas

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6
Q

What are cancers of adipose tissue called?

A

Liposarcomas

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7
Q

What is the most common GI cancer in western societies?

A

Colorectal Cancer

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8
Q

What are the different forms of colorectal cancer?

A

Sporadic, (age, no Fh)
Familial, (FH, ^ with close relative)
Hereditary Syndrome (FH, early onset, genetic defects)

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9
Q

What is the pathogenesis of colorectal cancer?

A

APC mutation causes hyperproliferative epithelium leading to formation of aberrant cryptic foci. With more genetic mutations (p53, K-ras) small adenoma become larger and form colon carcinomas

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10
Q

What are the risk factors for colorectal cancer?

A

Past history of colon conditions,
family history,
smoking,
obesity
diet - carcinogenic foods

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11
Q

What proportions of colorectal cancer are found in descending colon vs sigmoid colon?

A

2/3 descending colon // 1/3 sigmoid colon

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12
Q

What are the clinical presentations of caecal and right sided cancer?

A

Iron deficiency anaemia,
diarrhoea,
palpable mass and distal ileum obstruction (late onset)

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13
Q

What are the clinical presentations of sigmoid and left sided carcinoma?

A

PR (rectal) bleeding with mucus,
thin stool, tumour obstructing faecal passage

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14
Q

What are the clinical presentations of rectal carcinoma?

A

PR bleeding with mucus,
tenesmus,
anal, perineal, sacral pain (late)

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15
Q

Late signs of local invasion in colorectal cancer

A

Bladder symptoms
female genital tract symptoms

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16
Q

How can you identify metastasis of colorectal cancer

A

Liver (hepatomegaly, jaundice)
Lung (cough/monomorphic wheeze),
Regional lymph nodes
Bone Pain,
Umbilicus (Sister Marie Joseph nodule)

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17
Q

How can you examine a patient for primary colorectal cancer?

A

Abdo mass causing large bowel obstruction, <12cm digital rectal examination,
rigid sigmoidoscopy
abdo tenderness (obstruction)

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18
Q

What blood tests can you use for colorectal cancer?

A

FBC (for anaemia and haematinics - ferritin) Tumour Markers (CEA)

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19
Q

What tests can you do for faecal occult blood in colorectal cancer?

A

FIT (Faecal Immunochemical Test) - blood traces
Guaiac (Hemoccult) Test - H2O2 reacts to blood in sample

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20
Q

How do you visualise small lesions in colorectal cancer?

A

Colonoscopy for <5mm
can remove small lesions

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21
Q

How do you visualise larger lesions?

A

CT colonoscopy for >5mm
less invasive, no sedation needed
(colonoscopy needed for diagnosis)

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22
Q

What other imaging do you do for colorectal cancer?

A

MRI of pelvis - lymph node involvement and choosing btw radiotherapy / surgery. Identify cancer resection margin
CT chest, abdo, pelvis - staging/check for mets

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23
Q

What is the management for colorectal cancer that can precede surgery?

A

Stent, Radiotherapy, Chemotherapy

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24
Q

How do you surgically treat right and transverse colon carcinoma?

A

Resection and primary anastomosis

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25
Q

What are the options for surgically treating a left side obstruction?

A

Hartmann’s Procedure (proximal end colostomy), Primary Anastomosis,
Palliative stent

blood supply is not as good .: ^ risk of complications

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26
Q

What are the options for right sided cancer resection?

A

Right Hemicolectomy (remove right colon) or extended right hemicolectomy (right and some transverse colon). Both is followed by an ileocolic anastomosis

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27
Q

Process of left sided colon cancer resection

A

Remove left colon (descending)
anastomosis btw sigmoid and transverse colon

28
Q

What does resection look like in rectal cancer?

A

Remove rectum and sigmoid colon, leaving colon and anus
Can also replace the rectum with pouches of small bowel

29
Q

What are the 4 types of liver cancer?

A

Hepatocellular Carcinoma,
Gall Bladder cancer,
Cholangiocarcinoma,
Secondary Liver Metastases

30
Q

What is hepatocellular carcinoma - HCC

A

Cancer of the hepatocytes
usually with liver cirrhosis (alcohol induced/Hep B/C)

31
Q

What is NASH

A

Non-alcoholic steatohepatitis
Fatty liver inflammation leads to development of cancer

32
Q

What are the treatment options for HCCs?

A

Chemotherapy ineffective,
liver transplant
Resection

33
Q

What is the aetiology of gallbladder cancer?

A

mainly Unknown,
gallstones,
porcelain gallbladder - end stage inflammation with calcification
Chronic typhoid infection

34
Q

What are the treatment options for gallbladder cancer?

A

Chemotherapy ineffective, surgical excision with curative intent

35
Q

What is the aetiology of cholangiocarcinoma?

A

Primary Sclerosing Cholangitis - inflammation of the biliary tree
Ulcerative Colitis
Cholechondral cyst
liver fluke - parasites causing inflammation

36
Q

What are the treatment options for cholangiocarcinoma?

A

Chemotherapy ineffective, surgical excision with curative intent

37
Q

What are the two types of secondary liver metastases?

A

Synchronous (diagnosed within 6 months of primary)
Metachronous (diagnosed after 6 months of primary diagnosis) suggest adjuvant chemo to destroy mini mets

38
Q

What are the treatment options for secondary liver metastases?

A

Chemotherapy improving but mostly surgical excision with curative intent

39
Q

What is the most common form of pancreatic carcinoma?

A

Pancreatic Ductal Adenocarcinoma

40
Q

What are the risk factors for pancreatic cancer?

A

Chronic pancreatitis, - main risk
cigarette smoking,
T2DM,
high fat and ethanol diet,
family history

41
Q

What is the pathogenesis of pancreatic cancer?

A

Starts with non-invasive neoplastic precursor lesions (Pancreatic Intraepithelial Neoplasias). Further genetic and epigenetic mutations increase size of carcinoma

42
Q

What are the clinical signs of carcinoma of the head of the pancreas?

A

Jaundice (from blocking common bile duct), Weight Loss, Pain, GI Bleeding

43
Q

What are the clinical signs of carcinoma of the body & tail of pancreas?

A

Weight loss and back pain, but mostly asymptomatic until late stage

43
Q

What is the problem with tumour marker CA19-9 in diagnosing cancer?

A

Falsely elevated in pancreatitis and obstructive jaundice

43
Q

What are the investigations for pancreatic cancer?

A

Tumour Marker CA19-9, - monitoring not diagnostic
Ultrasonography, identify tumours and mets
Dual-Phase CT, shows invasion and mets

44
Q

What other investigations can you do for pancreatic cancer?

A

MRI, MRCP, ERCP

45
Q

What can you see on an ERCP?

A

Double Duct Sign - dilatation of bile and pancreatic duct
diagnose via biopsy

46
Q

How can you detect small pancreatic tumours?

A

Endoscopic Ultrasound

47
Q

Difference btw biopsy and cytology

A

Biopsy gives you histology
cytology, you aspirate to look at single cells

48
Q

What is laparoscopy and PET used for?

A

Detecting occult metastases

49
Q

Broadly what cells do NETs target?

A

Secretory cells of neuroendocrine system

50
Q

Where do NET’s arise from

A

Gastroenteropancreatic tract
bronchopulmonary system

51
Q

Genetic syndrome underlying NETs

A

Multiple endocrine neoplasia type 1 (MEN1)
causes parathyroid/pancreatic/pituitary tumours

52
Q

What are the effects NETs can cause?

A

Carcinoid Syndrome, Vasodilation, Bronchoconstriction, Endocardial Fibrosis

Vast majority are asymptomatic

53
Q

How do you diagnose NETs?

A

Biochemical Assessment (chromogranin A, gut hormones, calcium)
Imaging (CT/MRI, endoscopy, endoscopic ultrasound)

54
Q

What are the different treatments for NETs?

A

Curative Resection, Liver Transplant, Radiotherapy or Targeted biotherapy

55
Q

Differentials for dysphagia (difficulty swallowing)

A

Abdo - upper dysphagia: pharyngeal cancer, Parkinson’s, MNS
- lower dysphagia: oesophageal/lung cancer, achalasia, stricture
Cardiac - post-prandial angina

56
Q

Indications of oesophageal origin of dysphagia

A

upper - food painful on swallowing
lower - food easy to swallow but feels stuck later

57
Q

Indications of neurological origin of dysphagia

A

Both solids and lqs hard to swallow

58
Q

Causes of microcytic anaemia

A

Iron deficiency anaemia
chronic disease
thalassaemia

59
Q

Causes of normocytic anaemia

A

Aplastic anaemia
Bleeding
Chronic disease
Destruction (haemolysis)
Endocrine disorders
- Hypothyroidism
- Hypoadrenalism

60
Q

Causes of macrocytic anaemia
FAT RBC

A

Foetus (pregnancy)
Alcohol excess
Thyroid disorders
Reticulocytosis
B12/Folate deficiency
Cirrhosis

61
Q

Causes of iron deficiency anaemia

A

Blood loss
- increased demand (preggers)
- decreased absorption
GI causes
- cancer
- NSAIDs/aspirin
- H.pylori
Non GI causes
- menstruation

62
Q

Generic symptoms of malignancy

A

weight loss
anorexia
malaise - general discomfort

63
Q

Symptoms suggestive of colorectal cancer

A

Change in bowel habit
Blood or mucus in stool
Faecal incontinence
Feeling of incomplete emptying of bowels (tenesmus)

Gastro (10 decks)

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