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GENERAL SURGERY > GI Cancers > Flashcards

GI Cancers Flashcards

1
Q

define carcinoma

A

malignancy of cells that make up the epithelial lining of skin or tissue lining organs

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2
Q

define adenocarcinoma

A

malignancy of glandular cells in epithelial tissue

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3
Q

define adenoma

A

benign tumour formed from glandular structures in epithelial tissue

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4
Q

describe the histology of oesophageal cancer

A

Most commonly squamous cell carcinomas worldwide
* Generally upper 2/3rd
Adenocarcinomas from columnar epithelium can occur in the lower 1/3rd
* Barrett’s oesophagus

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5
Q

describe the clinical presentation of oesophageal cancer

A
  • Most commonly present with progressive dysphagia
  • Initially solids are more difficult to swallow than fluids (physical obstruction)
  • This becomes progressively worse, until its hard to swallow liquids too
  • Odynophagia (pain on swallowing)
  • Unexplained weight loss
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6
Q

what are red flags of oesophageal cancer (ALARM)

A
  • Anaemia
  • Loss of weight (unintentional)
  • Anorexia
  • Recent onset of progressive symptoms
  • Malaena(or Masses)
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7
Q

what are risk factors of oesophageal cancer

A
  • Squamous Cell Carcinomas - smoking, alcohol use, dietary intake e.g. hot beverages
  • Adenocarcinomas - obesity, reflux disease, most arise in background of Barrett’s oesophagus
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8
Q

what is the prognosis of oesophageal cancer

A

poor with 5% survival at 5 years

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9
Q

what investigations are carried out in oesophageal cancer

A

blood tests - FBC
- anaemia

oesophagogastroduodenoscopy(OGD) with biopsy
- can help determine whether benign or cancerous cause

CT thorax and abdomen
- size of primary, local invasion, metastatic spread

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10
Q

what is the treatment for oesophageal cancer

A

depends on stage
* Endoscopic therapies (for limited disease)
* Oesophagectomy(removal of oesophagus)
* Chemoradiotherapy

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11
Q

describe the histology of gastric cancer

A
  • most commonly adenocarcinomas
  • can get lymphoma, leiomyosarcoma, neuroendocrine tumours
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12
Q

where are adenocarcinomas most commonly found

A

adenocarcinomas are most often found in the gastric cardia (31%), followed by the antrum (26%), and body of the stomach (14%)

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13
Q

how are gastric cancers classified

A

location
* cardia gastric cancer-similar presentation to oesophageal cancer
* non-cardia gastric cancer-arises in other parts of the stomach

type (Lauren classification)
- diffuse (occurs more often in young patients and has a worse prognosis than intestinal type): poorly differentiated
- intestinal
- can also be mixed

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14
Q

what are risk factors of gastric cancer - 3 categories

A

general
- age 50-70
- male

strong
- pernicious anemia
- H-pylori
- N-nitroso compounds

weak
- family history
- high salt (weakens gastric mucosa and enhances -ve effects on N-nitroso compounds)
- smoking

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15
Q

what is the clinical presentation of gastric cancer

A

➢ Unexplained weight loss
➢ Epigastric abdominal pain
➢ Lymphadenopathy - Virchow’s node (left supraclavicular node)
➢ Dysphagia (if cancer is located around the cardia)

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16
Q

what is the prognosis of gastric cancer

A
  • 70% 5-year survival for local disease
  • 5% if distant metastasis
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17
Q

what are the investigations for gastric cancer

A
  • Bloods - anaemia
  • Upper GI endoscopy and biopsy-for tissue diagnosis
  • CT CAP (chest, abdomen and pelvis)-for staging/determining extent of disease
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18
Q

what is the management of gastric cancer at different stages

A
  • superficial - endoscopic mucosal resection
  • localised - surgery to remove all or part of the stomach (gastrectomy) BUT if not suitable for surgery then chemoradiation
  • advanced/metastatic- chemotherapy/immunotherapy and supportive care
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19
Q

describe the histology of pancreatic cancer

A
  • pancreatic ductal adenocarcinoma is the main histologic type of pancreatic cancer
  • pancreatic neuroendocrine tumours are rare and originate from the endocrine cells in the pancreas
  • they may be non-functional, or they may secrete hormones e.g. insulinoma= insulin
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20
Q

what are risk factors of pancreatic cancer

A
  • Smoking
  • Chronic pancreatitis
  • Inherited mutations inBRCA1,BRCA2, andPALB2and with familial syndromes
  • Men>women, plus increasing age
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21
Q

describe the clinical presentation of pancreatic cancer

A
  • Painless jaundice, unexplained weight loss, can present with abdominal/back pain
    - it is painless if the obstruction is in the head of the pancreas but will be painful if elsewhere
  • New-onset type 2 diabetes mellitus in an adult over 50 years of age without any obesity-related risk factors
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22
Q

what are the symptoms of pancreatic cancer

A
  • indigestion
  • tummy pain or back pain
  • changes to faeces
  • unexplained weight loss or loss of appetite
  • jaundice
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23
Q

what investigations are carried out in pancreatic cancer

A
  • bloods: LFTs if jaundiced, CA 19-9
  • CT- focused on pancreas can give very high diagnostic accuracy and can assess resectabilityin 80-90%
  • USS - can detect cancer arising in the head with reasonable accuracy but not in the body or tail
  • may biopsy (EUS-FNA)
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24
Q

describe the management of pancreatic cancer

A
  • 10-15% are suitable for surgical resection called a Whipple (followed by pancreatic enzyme replacement to replace lost exocrine function)
  • 20% 5 year survival
  • biliary stenting for jaundice
  • chemotherapy, potentially radiotherapy and symptom management
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25
Q

describe the histology of a hepatocellular carcinoma

A

primary cancer arising from hepatocytes usually w a background of cirrhosis

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26
Q

what are risk factors for hepatocellular carcinoma

A
  • most HCCs occur in pt w underlying cirrhosis
  • many causes of this incl: alcohol, Hep B&C
27
Q

describe the clinical presentation of hepatocellular carcinoma

A
  • as most HCC occurs in those w underlying liver disease, those symptoms can often mask the malignancy e.g. ascites, fatigue
  • acute hepatic decompensation or right upper quadrant pain can be signs of the development of HCC
28
Q

what is the prognosis of hepatocellular carcinoma

A
  • 5-year survival rate= approx. 50% with complete surgical resection or liver transplantation
  • advanced HCC= median overall survival time with treatment is approx. 1 year
29
Q

what investigations are carried out in hepatocellular carcinoma

A
  • Blood tests:
    ➢ LFTs
    ➢ Prothrombin time/INR (check synthetic function of the liver)
    ➢ Viral hepatitis panel
  • USS-Non invasive and a good way to screen high risk individuals
  • CT/MRI abdomen
  • Liver Biopsy
30
Q

describe treatment for hepatocellular carcinoma

A
  • If suitable then ablation, resection or transplantation
  • If not suitable for the above, then chemotherapy/immunotherapy aims to slow tumourgrowth
31
Q

what is a common site for metastases from many different cancer types

A

liver

32
Q

describe the different modes of spread of liver metastases

A
  • haematological e.g. portal spread from other GI viscera
  • lymphatic
  • transcoelomic
33
Q

what is a cholangiocarcinoma

A

bile duct cancer

34
Q

describe the histology of cholangiocarcinoma

A
  • majority are adenocarcinomas
  • can be intrahepatic/extrahepatic
35
Q

what are risk factors of cholangiocarcinomas

A
  • Liver and bile duct diseases-cirrhosis, alcoholic liver disease, non-specific bile duct diseases (e.g. bile duct adenoma), gallstones, PSC
  • Infections
  • High alcohol consumption
  • Exposure to certain toxins/medications e.g. isoniazid
36
Q

what is the prognosis of a cholangiocarcinoma

A
  • Poor prognosis generally, five-year overall survival rate in patients with metastatic disease is 2%
  • Treatments include surgical and non-surgical options
37
Q

describe the histology of colorectal cancer

A

adenocarcinomas which progress from normal epithelium in a classical pattern

38
Q

what are risk factors of colorectal cancer

A
  • Dietary factors-high dietary fat, high red meat consumption, low dietary fibre, alcohol intake
  • A history of inflammatory bowel disease (IBD)
  • Genetic conditions; familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC)
39
Q

describe the clinical presentation of colorectal cancer

A
  • Most commonly presents with blood in the stool and altered bowel habits
  • Advanced cases can manifest with bowel obstruction or perforation or symptoms due to hepatic or peritoneal metastases e.g. abdominal pain and ascites
40
Q

what is the prognosis of colorectal cancer

A
  • Among gastrointestinal cancers, colorectal cancer has the best overall prognosis
  • For non-metastatic disease, the 5-year survival rate ranges from 50% to 95%
41
Q

what are red flags of colorectal cancer

A
  • Blood in the stool/rectal bleeding (fresh red blood vs mixed in the stool vs malaena)
  • Change in bowel habit (age, frequency, consistency)
  • Iron deficiency anaemia
  • Unexplained weight loss
  • Tenesmus
  • Mass on rectal examination
42
Q

compare and contract right sided vs left sided colon cancer

A
43
Q

what is the adenocarcinoma sequence

A

series of genetic and epigenetic mutations leading to activation of oncogenes and inactivation of tumour suppressor genes e.g. P53

  1. normal glandular epithelial cells
  2. adenomas (benign neoplasms)
  3. invasive carcinomas
44
Q

what are investigations into colorectal cancer

A
  • Stool tests - e.g. FIT
  • Blood tests - FBC for anaemia, CEA
  • Colonoscopy and biopsy
  • Imaging - CT, MRI
45
Q

what is the management of colorectal cancer

A
  • Largely dependent on stage
  • Surgery with pre or post-operative chemotherapy/immunotherapy
  • Chemotherapy/immunotherapy if notfor surgical intervention
46
Q

what are some barriers to participation in bowel cancer screening

A
  • fear and denial around the test outcome
  • individual perceived low risk/ don’t want to know result
  • males less likely to take part
  • lower socioeconomic group
  • lower uptake amongst ethnic minority groups
  • misconception that test is not applicable if no symptoms
  • concerns about practicalities/cleanliness of test
  • low health literacy and numeracy
47
Q

what is the histology of anal cancer

A

typically squamous cell carcinoma

48
Q

what are risk factors of anal cancer

A
  • Strongly associated with human papillomavirus (HPV) infection
  • Human immunodeficiency virus (HIV) infection
  • Engaging in anal-receptive sexual intercourse
  • Chronic local inflammation due to IBD or recurrent anal fissures
49
Q

what is the clinical presentation of anal cancer

A
  • perianal pruritus or pain
  • bleeding
  • discharge
  • mass like sensation
50
Q

what is the prognosis of anal cancer

A
  • more than 70% cases can be cured with chemoradiation
  • pap smears in high-risk populations and better prevention and treatment of HIV infection should lower the incidence
51
Q

how is colorectal cancer staged

A

Dukes’ staging

52
Q

describe Dukes’ staging of colorectal cancer

A
53
Q

what are the incidences of GI cancers

A

breast/prostate
- bowel (large bowel)
- pancreas
- oesophagus
- stomach
- liver

54
Q

A 55-year-old man presents with severe dysphagia to solids and worsening dysphagia to liquids. His social history is significant for 40 pack-year cigarette smoking and a 6-pack of beer per day. He has lost over 10% of his body weight and currently is nourished only by milkshake supplements. He complains of some mild odynophagia and is constantly coughing up mucus secretions

what is his likely diagnosis

A

oesophageal cancer

55
Q

A 77-year-old man presents to his general practitioner with weight loss of 6.8 kg (15 lbs) and a 3-month history of dysphagia and abdominal pain. The only abnormal finding on physical examination is stools positive for occult blood

what is his likely diagnosis

A

gastric cancer

56
Q

A 45-year-old woman presents to her physician with vague upper abdominal (epigastric) pain. After treatment with proton-pump inhibitors, analgesics, and antacids over a period of 3 months, which were ineffective, the patient also started to experience back pain. This prompted an initial upper gastrointestinal endoscopy, which was normal. Nearly 4 months after initial presentation, an upper abdominal ultrasound reveals a pancreatic mass with liver metastases

what is her likely diagnosis

A

pancreatic cancer

57
Q

A 60-year-old man with a long-standing history of chronic hepatitis B virus infection complicated by cirrhosis presents to his primary care physician with abdominal distension, yellow eyes, right upper quadrant (RUQ) abdominal pain, decreased appetite, weight loss, and change in his sleep pattern for several weeks. Physical examination reveals a cachectic man with jaundice, palmar erythema, ascites, a palpable mass in RUQ, and asterixis

what is the likely diagnosis

A

hepatocellular carcinoma

58
Q

label this diagram showing the progression of the liver to hepatocellular carcinoma

A
59
Q

A 70-year-old man presents to his primary care physician with a complaint of rectal bleeding. He describes blood mixed in with the stool, and a change from his normal bowel habit as he is going more frequently than normal. He has also experienced some crampy leftsided abdominal pain and weight loss. He has previously been fit and well and there is no family history of gastrointestinal disease. Examination of his abdomen and digital rectal examination are normal

what is the likely diagnosis

A

colorectal cancer

60
Q

why is bowel obstruction more likely in left sided colon cancer

A

shorter

61
Q

why is there occult bleeding in right sided colon cancer but rectal bleeding in the left

A
  • in right sided colon cancer there is still time for modification of the blood through the passage of the colon where as there is not in left sided
  • so not visible to naked eye in right sided
62
Q

what does this MRI show

A

apple core sign showing stenosing of colon

63
Q

A 50-year-old man presents to his family physician with bright red blood per rectum. He denies anal pain or trauma, a history of HIV or high-risk sexual partners, immunosuppression, or other constitutional symptoms. Anal continence is normal. On examination there is a 1.5 cm firm mass in the anal canal. There is no invasion of the prostate. His abdomen is soft and there is no abdominal tenderness. Bilateral inguinal nodes are clinically negative. His full blood count is normal

what is the likely diagnosis

A

anal cancer

64
Q

blood supply to the oesophagus

A

GENERAL SURGERY (10 decks)

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