GI Cancers Flashcards
What are the 2 main histological types of oesophageal cancer?
Squamous cell carcinoma
Adenocarcinoma
What is the difference between where squamous cell carcinoma’s and adenocarcinoma’s affect the oesophagus?
SCC - proximal 2/3
Adenocarcinoma - distal 1/3
What are the risk factors for squamous cell carcinoma of the oesophagus?
Smoking Alcohol Strictures Achalasia HPV infection Plummer-vinson
What are the risk factors for adenocarcinoma of the oesophagus?
GORD
Barrett’s oesophagus
Obesity
Smoking
How do oesophageal cancers present?
Often present late as 75% of oesophagus must be occluded before “food sticking” symptoms
Dysphagia - solid --> liquid Weight loss and anorexia Vomiting Upper GI bleeds - anaemia, melaena Painful swallowing (odynophagia) Hoarse voice Retrosternal pain
How is oesophageal cancer staged?
TNM staging
How are oesophageal cancers investigated?
Upper GI endoscopy with biopsy
CT CAP - staging
Endoscopic USS for assessing local tumour invasion
How is oesophageal cancer managed?
Ivo-Lewis esophagectomy
How is oesophageal cancer managed palliatively?
Stenting
Radio, chemo, brachytherapy, laset ablation, photodynamic therapy considered
What is crucial to consider in patients with oesophageal cancer?
Nutrition through every stage as they are malnourished due to dysphagia
What are the complications of an oesophagectomy?
!!Anastomotic leak = mediastinitis!! Pneumonia Atelectasis MI AF Recurrent laryngeal nerve damage
Where in the world does gastric cancer have the highest incidence?
GORD and obesity are associated with which gastric cancer?
Highest in Eastern Asia
Carcinoma of cardia - incidence is rising
What are common risk factors for gastric cancer?
H Pylori Smoking Blood group A Pernicious anaemia Salty/spicy diet Gastric adenomatous polyps
What are the indications for 2 week wait biopsy for gastric cancer?
> 55 + dyspepsia
<55 + dyspepsia + another symptom/risk factor
What other symptoms would indicate a 2 week wait biopsy for gastric cancer?
Anaemia
LFT changes
What is the gold standard investigation for gastric cancer?
Endoscopy with biopsy
Then CT or endoscopic USS
How is Gastric cancer staged?
TNM
Where are most stomach cancers found?
50% pyloric
25% lesser curve
10% each fundus/body + cardia
5% greater curve
What signs/symptoms may a patient with gastric cancer present with?
Dyspepsia
N&V
Weight loss, anorexia, early satiety
Dysphagia
Anaemia
Virchow’s and Sister Mary Josephs Node
Jaundice
Palpable mass
How are gastric cancers managed?
Gastrectomy + lymphadenectomy + chemo
What are the possible complications of gastrectomy?
Splenic/short gastric vessel tear Anastomotic leak Anaemia Dumping syndrome Impaired fat absorption Osteomalacia Osteoporosis
How is gastric cancer managed palliatively?
Chemo
Surgical intervention, stenting, endoscopic dilation for obstruction
Blood transfusion –> anaemia
Corticosteroids –> anorexia
On auscultation of the stomach in a distal gastric cancer what might be heard?
Succession splash - slooshing noise indicating gastric outlet obstruction
What does GIST stand for and what type of tumours are they?
gastrointestinal stromal tumour
They are soft tissue sarcomas
Where GISTs found?
Mostly stomach but also small and large bowel
How does GISTs present?
Anaemia (due to GI bleed)
Early satiety and bloating
Fever, night sweats and weight loss
How are GISTs managed? (Investigations and treatments)
Do not biopsy as risk of seeding Give Imatinib (tyrosine kinase inhibitor)
What is the histology of pancreatic cancers? Where are they found most commonly?
Adenocarcinomas
Head of the pancreas
What are the risk factors for developing pancreatic cancer?
Chronic pancreatitis
Smoking
Diabetes
HNPCC, MEN, BRCA2, KRAS
How may pancreatic cancer present?
Painless jaundice
Pruritis
Atypical back pain/epigastric pain
Weight loss
Failing endocrine: diabetes
Failing exocrine: steatorrhea
What is Courvoisers law?
A palpable gallbladder is unlikely to be due to gallstones in a painless jaundice picture
How is pancreatic cancer investigated? (Key blood results and imaging)
Cholestatic LFTs
High resolution CT: double duct sign (dilation of common bile and pancreatic ducts)
What is the surgical management of pancreatic cancer? What are complications of this?
Whipples
- dumping syndrome
- peptic ulcer disease
What is the palliative management of pancreatic cancer?
Stents
ERCP
What are the complications of a gastroscopy?
sore throat
aspiration pneumonia
perforation
What are the complications of a colonoscopy?
rectal bleeding
infection
perforation
