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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
What are the options for surgically treating a left side obstruction?
Hartmann's Procedure (proximal end colostomy), Primary Anastomosis, Palliative stent blood supply is not as good .: ^ risk of complications
26
What are the options for right sided cancer resection?
Right Hemicolectomy (remove right colon) or extended right hemicolectomy (right and some transverse colon). Both is followed by an ileocolic anastomosis
27
Process of left sided colon cancer resection
Remove left colon (descending) anastomosis btw sigmoid and transverse colon
28
What does resection look like in rectal cancer?
Remove rectum and sigmoid colon, leaving colon and anus Can also replace the rectum with pouches of small bowel
29
What are the 4 types of liver cancer?
Hepatocellular Carcinoma, Gall Bladder cancer, Cholangiocarcinoma, Secondary Liver Metastases
30
What is hepatocellular carcinoma - HCC
Cancer of the hepatocytes usually with liver cirrhosis (alcohol induced/Hep B/C)
31
What is NASH
Non-alcoholic steatohepatitis Fatty liver inflammation leads to development of cancer
32
What are the treatment options for HCCs?
Chemotherapy ineffective, liver transplant Resection
33
What is the aetiology of gallbladder cancer?
mainly Unknown, gallstones, porcelain gallbladder - end stage inflammation with calcification Chronic typhoid infection
34
What are the treatment options for gallbladder cancer?
Chemotherapy ineffective, surgical excision with curative intent
35
What is the aetiology of cholangiocarcinoma?
Primary Sclerosing Cholangitis - inflammation of the biliary tree Ulcerative Colitis Cholechondral cyst liver fluke - parasites causing inflammation
36
What are the treatment options for cholangiocarcinoma?
Chemotherapy ineffective, surgical excision with curative intent
37
What are the two types of secondary liver metastases?
Synchronous (diagnosed within 6 months of primary) Metachronous (diagnosed after 6 months of primary diagnosis) suggest adjuvant chemo to destroy mini mets
38
What are the treatment options for secondary liver metastases?
Chemotherapy improving but mostly surgical excision with curative intent
39
What is the most common form of pancreatic carcinoma?
Pancreatic Ductal Adenocarcinoma
40
What are the risk factors for pancreatic cancer?
Chronic pancreatitis, - main risk cigarette smoking, T2DM, high fat and ethanol diet, family history
41
What is the pathogenesis of pancreatic cancer?
Starts with non-invasive neoplastic precursor lesions (Pancreatic Intraepithelial Neoplasias). Further genetic and epigenetic mutations increase size of carcinoma
42
What are the clinical signs of carcinoma of the head of the pancreas?
Jaundice (from blocking common bile duct), Weight Loss, Pain, GI Bleeding
43
What are the clinical signs of carcinoma of the body & tail of pancreas?
Weight loss and back pain, but mostly asymptomatic until late stage
43
What is the problem with tumour marker CA19-9 in diagnosing cancer?
Falsely elevated in pancreatitis and obstructive jaundice
43
What are the investigations for pancreatic cancer?
Tumour Marker CA19-9, - monitoring not diagnostic Ultrasonography, identify tumours and mets Dual-Phase CT, shows invasion and mets
44
What other investigations can you do for pancreatic cancer?
MRI, MRCP, ERCP
45
What can you see on an ERCP?
Double Duct Sign - dilatation of bile and pancreatic duct diagnose via biopsy
46
How can you detect small pancreatic tumours?
Endoscopic Ultrasound
47
Difference btw biopsy and cytology
Biopsy gives you histology cytology, you aspirate to look at single cells
48
What is laparoscopy and PET used for?
Detecting occult metastases
49
Broadly what cells do NETs target?
Secretory cells of neuroendocrine system
50
Where do NET's arise from
Gastroenteropancreatic tract bronchopulmonary system
51
Genetic syndrome underlying NETs
Multiple endocrine neoplasia type 1 (MEN1) causes parathyroid/pancreatic/pituitary tumours
52
What are the effects NETs can cause?
Carcinoid Syndrome, Vasodilation, Bronchoconstriction, Endocardial Fibrosis Vast majority are asymptomatic
53
How do you diagnose NETs?
Biochemical Assessment (chromogranin A, gut hormones, calcium) Imaging (CT/MRI, endoscopy, endoscopic ultrasound)
54
What are the different treatments for NETs?
Curative Resection, Liver Transplant, Radiotherapy or Targeted biotherapy
55
Differentials for dysphagia (difficulty swallowing)
Abdo - upper dysphagia: pharyngeal cancer, Parkinson's, MNS - lower dysphagia: oesophageal/lung cancer, achalasia, stricture Cardiac - post-prandial angina
56
Indications of oesophageal origin of dysphagia
upper - food painful on swallowing lower - food easy to swallow but feels stuck later
57
Indications of neurological origin of dysphagia
Both solids and lqs hard to swallow
58
Causes of microcytic anaemia
Iron deficiency anaemia chronic disease thalassaemia
59
Causes of normocytic anaemia
Aplastic anaemia Bleeding Chronic disease Destruction (haemolysis) Endocrine disorders - Hypothyroidism - Hypoadrenalism
60
Causes of macrocytic anaemia FAT RBC
Foetus (pregnancy) Alcohol excess Thyroid disorders Reticulocytosis B12/Folate deficiency Cirrhosis
61
Causes of iron deficiency anaemia
Blood loss - increased demand (preggers) - decreased absorption GI causes - cancer - NSAIDs/aspirin - H.pylori Non GI causes - menstruation
62
Generic symptoms of malignancy
weight loss anorexia malaise - general discomfort
63
Symptoms suggestive of colorectal cancer
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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