GI cancers Flashcards
Pancreatic types
Insulinoma
Glucagonoma
Pancreatic/duodenal type
Gastrinoma
Entire GI type
VIPoma
Somatostatinoma
Insulinoma clinical features and cell type
Hypoglycaemia
Whipple’s triad
Beta
Glucagonoma clinical features and cell type
DM
necrolytic migratory erythema
Alpha
Gastrinoma clinical features and cell type
Zollingere-Ellison syndrome
G
VIPoma clinical features and cell type
Verner-morrison syndrome
Watery diarrhea
VIP
Somatostatinoma clinical features and cell type
Gallstone
DM
steatorrhoea
D
Midgut clinical features
Most non functioning
40%- carcinoid syndrome
Hindgut clinical features
Usually non functioning
cancer connective tissue: smooth muscle/adipose tissue name
smooth muscle= leiomyoma
adipose tissue= liposarcoma
cancer of Neuroendocrine Cells:
Enteroendocrine cells
Interstitial cells of Cajal
name
Enteroendocrine cells = neuroendocrine tumours (NET)
Interstitial cells of Cajal= gastrointestinal stromal tumours
cancer cells of epithelial cells:
squamous
glandular epithelium
name
-squamous= squamous cell carcinoma
-glandular epithelium =adenocarcinoma
histopathology of colorectal cancer
adenocarcinoma
clinical presentation of colorectal cancer - caecal+right sided cancer,
Left sided & sigmoid carcinoma,
Rectal carcinoma,
Bowel obstruction (late)
caecal+right sided cancer=
-Iron deficiency anaemia (most common)
-Change of bowel habit (diarrhoea)
Left sided & sigmoid carcinoma=
PR bleeding, mucus
Thin stool (late)
Rectal carcinoma=
PR bleeding, mucus
Tenesmus
Anal, perineal, sacral pain (late)
Bowel obstruction (late)
colorectal cancer-presentation (late) - local invasion vs metastasis
Local invasion (late)
-Bladder symptoms
-Female genital tract symptoms
Metastasis (late)
-Liver (hepatic pain, jaundice)
-Lung (cough)
-Regional lymph nodes=Sister Marie Joseph nodule
Colorectal cancer - investigations
Faecal occult blood – detects tiny amounts of blood in faeces
FBC – anaemia
Tumour markers – CEA (for monitoring – NOT diagnostic)
Imaging – colonoscopy= visualise lesions smaller than 5mm; small polyps can be removed too
Imaging - CT colonoscopy for lesions bigger than 5mm
Colorectal cancer - management
Surgery
Right + transverse=
resection + primary anastomosis
Left sided= hartmanns procedure
liver cancer-> Primary liver cancer (hepatocellular carcinoma)
Maj- underlying CIRRHOSIS
Poor prognosis
Chemotherapy is ineffective
Surgical RESECTION is optimal but only 5-15% are suitable for surgery
Affected part removed and nothing else
liver cancer-> Gallbladder cancer
Poor prognosis
Chemotherapy ineffective
Surgical EXCISISON is optimal
Gallbladder and part of liver is removed
liver cancer-> Cholangiocarcinoma
Poor prognosis
Chemotherapy ineffective
Surgical RESECTION is optimal
Entire half of liver is removed
Liver cancer-> Secondary liver metastases
Liver common site of cancer metasteses
Surgical resection is optimal
pancreatic cancer- histopathology, onset of presentation, what increases the risk?
Common and highly lethal
Histopathology – pancreatic ductal adenocarcinoma
Late presentation
Very few have resectable disease
Chronic pancreatitis increases the risk
pancreatic cancer: presentation of head vs [body+ tail] cancer.
Head cancer presents with: Jaundice + weight loss + pain
Body + tail presents with: Asx early; weight loss + back pain + vomiting (late)
Neuroendocrine tumours- where do they arise? what do they secrete?
Arise from gastroenteropancreactic tract
Secretes HORMONES
Most asymptomatic + incidental finding
Carcinoid syndrome
pancreatic cancer- Investigation? treatment: head vs [body+ tail]
Investigation – 1st Abdo US; CA19-9
Treatment – Head – whipples resection.
Body + tail – remove tail w/ spleen
symptoms of carcinoid syndrome
vasodilation,
bronchoconstriction,
increased intestinal motility,
endocardial fibrosis
Neuroendocrine tumours - diagnosis- biochemical assessment
Chromogranin A – secretory produce of neuroendocrine tumours
Other gut hormones: insulin, gastrin, somatostatin, PPY (measure when fasting)
Other screening: Calcium, PTH, prolactin, GH
24 hr urinary 5-HIAA (serotonin metabolite)
Neuroendocrine tumours - diagnosis- imaging
CT and/or MRI
Bowel imaging (endoscopy, barium follow through, capsule endoscopy)
Endoscopic ultrasound
Somatostatin receptor scintigraphy
Neuroendocrine tumours- treatment
Surgery- curative resection
Somatostatin analogues (e.g. octeotride)
