GI Cancers Flashcards
Describe the incidence of various common cancers of the G.I. tract
Bowel = 4th most common malignancy
Pancreas, oesophagus, stomach, liver = top 20 most common malignancies
What is the differential diagnosis for dysphagia?
Extraluminal = compression
Luminal = integrity problem with the lumen
Intraluminal = foreign body
What are the red flags for dysphagia?
ALARM
Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Masses/malaena
What type of cancer is mainly seen in the oesophagus?
Due to the presence of stratified squamous ep = squamous cell carcinoma
Lower third = adenocarcinoma
What type of cancer is mainly seen in the GI tract (other than oesophagus)?
Due to presence of columnar ep = adenocarcinoma
How does oesophageal carcinoma present?
Progressive dysphagia
Barium swallow = narrowing
What is malaena?
Bleeding in upper GI tract
Gets metabolised
In stool = black, tar, offensive smell
Define haematemesis
Vomiting blood
What are the red flags when investigating epigastric pain?
Malaena
Haematemesis
What are the risk factors for gastric cancer?
Smoking
High salt diet
Family history
Where are gastric cancers typically found?
Cardia or antrum
Typically adenocarcinoma
How do gastric cancers present?
Similar pain to peptic ulcer
50% have palpable mass
Other than adenocarcinoma what other stomach cancer can occur?
Gastric lymphoma = most associated with H pylori
Gastrointestinal stromal tumours
What are the reg flags of jaundice?
Hepatomegaly = irregular border (worry about mets)
Ascites = pressure build up in portal system due to excess tissue build up, reduced liver function lower
Albumin levels
Painless = typically
Unintentional weight loss
What is the most common way GI cancer spreads?
Blood
Lymph
Transcoelomic – via a cavity
What cancers most commonly metastasise to the liver?
Breast
GI
How does pancreatic cancer present?
Pancreatic head = painless jaundice
Pancreatic tail = abdo pain, malabsorption, endocrine dysfunction
If someone has an enlarged, palpable, non-tender gallbladder then what is not the cause?
not gallstones
What symptoms are seen in a lower GI obstruction?
Abdo distention
Abdo pain
Constipation
Nausea and vomiting
What is a differential diagnosis for lower GI obstruction?
Benign = diverticular disease, volvulus, hernia
Malignant = adenocarcinoma of the large colon, small bowel cancer
Describe the symptoms of PR bleeding
Fresh bright red bleeding
Melena
Anal pain
Tenesmus
What is melena?
Bleeding higher up in the GI tract
Dark black, tarry stools
Foul smelling
Define tenesmus
Feeling of incomplete emptying
Name the reg flags of PR bleeding
Iron def anaemia = insidious bleeding higher up in GI tract
Unexplained weight loss
Age dependent
Change in bowel habit
What are the different causes of PR bleeding?
Benign = haemorrhoids, anal fissures, IBD
Malignancy = adenocarcinoma, small bowel cancer
What can cause a change in bowel habits?
Over active thyroid = looser stools
Under active thyroid = constipation
Metformin = runny stool
Irritable bowel
Coeliac disease
Malignancy = adenocarcinoma, small bowel cancer
What are the risk factors for large bowel cancer?
Family history
Inflammatory bowel disease
Polyposis syndromes - FAP
Diet and lifestyle
Describe the adenoma-carcinoma sequence relating to colorectal cancer
Genetic changes = polyp (benign growth) = can become hyperplastic = abnormal diff of cell type = dysplastic = potential to become cancerous
What are the risk factors for small bowel cancer?
IBD
Coeliac disease
FAP – polyposis syndromes
Diet
Any inflammatory process in the bowel puts you at a higher risk of what?
Bowel cancer
How is GI cancer managed?
TNM staging
Blood test- FBC (looking for iron def anaemia), tumour markers(CEA)
CT/MRI
Endoscopy/Colonoscopy
Capsule endoscopy
Treatment = Chemotherapy, radiotherapy, surgical resections
