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Cancer Care > GI Cancers > Flashcards

GI Cancers Flashcards

1
Q

What are the 2 main histological types of oesophageal cancer?

A

Squamous cell carcinoma

Adenocarcinoma

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2
Q

What is the difference between where squamous cell carcinoma’s and adenocarcinoma’s affect the oesophagus?

A

SCC - proximal 2/3

Adenocarcinoma - distal 1/3

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3
Q

What are the risk factors for squamous cell carcinoma of the oesophagus?

A 
Smoking
Alcohol
Strictures
Achalasia
HPV infection
Plummer-vinson
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4
Q

What are the risk factors for adenocarcinoma of the oesophagus?

A

GORD
Barrett’s oesophagus
Obesity
Smoking

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5
Q

How do oesophageal cancers present?

A

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
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6
Q

How is oesophageal cancer staged?

A

TNM staging

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7
Q

How are oesophageal cancers investigated?

A

Upper GI endoscopy with biopsy
CT CAP - staging
Endoscopic USS for assessing local tumour invasion

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8
Q

How is oesophageal cancer managed?

A

Ivo-Lewis esophagectomy

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9
Q

How is oesophageal cancer managed palliatively?

A

Stenting

Radio, chemo, brachytherapy, laset ablation, photodynamic therapy considered

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10
Q

What is crucial to consider in patients with oesophageal cancer?

A

Nutrition through every stage as they are malnourished due to dysphagia

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11
Q

What are the complications of an oesophagectomy?

A 
!!Anastomotic leak = mediastinitis!! 
Pneumonia
Atelectasis
MI
AF
Recurrent laryngeal nerve damage
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12
Q

Where in the world does gastric cancer have the highest incidence?

GORD and obesity are associated with which gastric cancer?

A

Highest in Eastern Asia

Carcinoma of cardia - incidence is rising

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13
Q

What are common risk factors for gastric cancer?

A 
H Pylori
Smoking
Blood group A
Pernicious anaemia 
Salty/spicy diet
Gastric adenomatous polyps
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14
Q

What are the indications for 2 week wait biopsy for gastric cancer?

A

> 55 + dyspepsia

<55 + dyspepsia + another symptom/risk factor

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15
Q

What other symptoms would indicate a 2 week wait biopsy for gastric cancer?

A

Anaemia

LFT changes

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16
Q

What is the gold standard investigation for gastric cancer?

A

Endoscopy with biopsy

Then CT or endoscopic USS

17
Q

How is Gastric cancer staged?

A

TNM

18
Q

Where are most stomach cancers found?

A

50% pyloric
25% lesser curve
10% each fundus/body + cardia
5% greater curve

19
Q

What signs/symptoms may a patient with gastric cancer present with?

A

Dyspepsia
N&V
Weight loss, anorexia, early satiety
Dysphagia

Anaemia
Virchow’s and Sister Mary Josephs Node
Jaundice
Palpable mass

20
Q

How are gastric cancers managed?

A

Gastrectomy + lymphadenectomy + chemo

21
Q

What are the possible complications of gastrectomy?

A 
Splenic/short gastric vessel tear
Anastomotic leak
Anaemia 
Dumping syndrome
Impaired fat absorption
Osteomalacia
Osteoporosis
22
Q

How is gastric cancer managed palliatively?

A

Chemo
Surgical intervention, stenting, endoscopic dilation for obstruction
Blood transfusion –> anaemia
Corticosteroids –> anorexia

23
Q

On auscultation of the stomach in a distal gastric cancer what might be heard?

A

Succession splash - slooshing noise indicating gastric outlet obstruction

24
Q

What does GIST stand for and what type of tumours are they?

A

gastrointestinal stromal tumour

They are soft tissue sarcomas

25
Q

Where GISTs found?

A

Mostly stomach but also small and large bowel

26
Q

How does GISTs present?

A

Anaemia (due to GI bleed)
Early satiety and bloating
Fever, night sweats and weight loss

27
Q

How are GISTs managed? (Investigations and treatments)

A 
Do not biopsy as risk of seeding
Give Imatinib (tyrosine kinase inhibitor)
28
Q

What is the histology of pancreatic cancers? Where are they found most commonly?

A

Adenocarcinomas

Head of the pancreas

29
Q

What are the risk factors for developing pancreatic cancer?

A

Chronic pancreatitis
Smoking
Diabetes
HNPCC, MEN, BRCA2, KRAS

30
Q

How may pancreatic cancer present?

A

Painless jaundice
Pruritis
Atypical back pain/epigastric pain
Weight loss

Failing endocrine: diabetes
Failing exocrine: steatorrhea

31
Q

What is Courvoisers law?

A

A palpable gallbladder is unlikely to be due to gallstones in a painless jaundice picture

32
Q

How is pancreatic cancer investigated? (Key blood results and imaging)

A

Cholestatic LFTs

High resolution CT: double duct sign (dilation of common bile and pancreatic ducts)

33
Q

What is the surgical management of pancreatic cancer? What are complications of this?

A

Whipples

  • dumping syndrome
  • peptic ulcer disease
34
Q

What is the palliative management of pancreatic cancer?

A

Stents

ERCP

35
Q

What are the complications of a gastroscopy?

A

sore throat
aspiration pneumonia
perforation

36
Q

What are the complications of a colonoscopy?

A

rectal bleeding
infection
perforation

Cancer Care (25 decks)

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