GI Cancers

Question 1

Most common type of pancreatic cancer

Answer 1

Ductal carcinoma

Question 2

Risk factors for pancreatic cancer

Answer 2

60+
Males
Family history
Diabetes mellitus
Chronic pancreatitis

Question 3

Clinical presentation of pancreatic cancer

Answer 3

Normally asymptomatc

Head of pancreas

• obstructive jaundice
• abdominal pain
• weight loss

Question 4

What is Courvoisier’s sign?

Answer 4

Painless jaundice + enlarged gallbladder

Pancreatic neoplasm until proven otherwise

Question 5

What is Trousseau sign of malignancy?

Answer 5

Medical sign involving episodes of vessel inflammation due to recurrent blood clots

Syndrome associated with pancreatic cancer

Question 6

Investigations for suspected pancreatic cancer

Answer 6

CT
ERCP

Tumour markers

• CA19-9
• CEA

Question 7

Management of pancreatic cancer

Answer 7

Radical resection- T1-2N0M0
remove pancreas head, antrum of stomach, 1st+2nd parts duodenum, CBD, gall bladder

Adjuvant chemotherapy

Adjuvant radiotherapy

Question 8

What is the Cochrane review?

Answer 8

Pancreatic resection increases survival and reduces costs compared to palliative treatment

Question 9

What is hepatocellulatr carcinoma?

Answer 9

Primary liver cancer

Associated with chronic inflammatory proceses affected the liver

Question 10

Risk factors of hepatocellular carcinoma

Answer 10

Hep B
Hep C
High alcohol intake
Aflatoxin
Smoking

Question 11

Clinical features of hepatocellular carcinoma

Answer 11

Dull upper abdo pain
Enlarged liver
Weight loss
Ascites

Question 12

Investigations for suspected hepatocellular carcinoma

Answer 12

LFTs
AFP - raised in 80% of cases
Ultrasound
CT

DO NOT BIOPSY

Question 13

Management of hepatocellular carcinoma

Answer 13

Surgical resection

Question 14

Common sites for liver metastases to come from

Answer 14

Bowel
Breast
Stomach
Pancreas
Lung

Question 15

What is cholangiocarcinoma?

Answer 15

Cancer of the biliary system

Common site = bifurcation of right and left hepatic ducts

Commonly adenocarcinomas

Question 16

Risk factors for cholangiocarcinoma

Answer 16

Primary sclerosing cholangitis
Ulcerative colitis
Infective (HIV, hepatitis)
Diabetes mellitus

Question 17

Clinical features of cholangiocarcinoma

Answer 17

Asymptomatic until late stage

Jaundice
Weight loss
Pruritus

Question 18

Investigations for suspected cholangiocarcinoma

Answer 18

Bloods - test for obstructive jaundice
Tumour markers - CA19-9
MRCP

Question 19

Management of cholangiocarcinoma

Answer 19

Surgical resection

PAliative stenting of bile duct

Question 20

Types of oesphageal cancer

Answer 20

Squamous cell carcinoma

• middle/upper thirds
• associated with smoking/alcohol consumption

Adenocarcinoma

• lower third
• consequence of Barrett’s oesophagus
• risk factor = GORD

Question 21

Clinical features of oesphageal cancer

Answer 21

Dysphagia - progressive solids to liquids
Significant weight loss
Dyspepsia

Question 22

Investigations for suspected oesphageal cancer

Answer 22

Endoscopy

Question 23

Management for oesphageal cancer

Answer 23

Mostly palliative

Question 24

Risk factors for gastric cancer

Answer 24

Male
H.pylori infection
Increasing age
Smoking

Question 25

Clinical features of gastric cancer

Answer 25

Dyspepsia Dysphagia Early satiety Possibility of epigastric mass

Question 26

Investigations for suspected gastric cancer

Answer 26

Endoscopy - biopsy CT for staging

Question 27

Management of gastric cancer

Answer 27

Gastrectomy - total for proximal tumour - subtotal for distal tumour Nutritional assessment Peri-operative chemotherapy

Question 28

What is colorectal cancer?

Answer 28

Cancer affecting large bowel 50% affect rectum + left colon Majority arise from adenomatous polyps

Question 29

How do colorectal cancers spread?

Answer 29

Direct - radial from retropeitoneal organs - radial from intraperitoneal organs Lymphatic - paracolic nodes - intermediate colic nodes - para-aortic node Blood borne - liver via portal system - lungs Transcoloemic

Question 30

Risk factors for colorectal cancers

Answer 30

Genetic - lynch syndrome - FAP Diet - alcohol - red meat - obesity Predisposing conditions - IBD - previous abdo surgery

Question 31

Clinical features of right sided colon cancer

Answer 31

``` Abdominal pain Occult bleeding Mass in RIF Change in bowel habits Iron deficiency anaemia ```

Question 32

Clinical features of left sided colon cancer

Answer 32

``` Changes in bowel habits Rectal bleeding Tenesmus Mass in LIF Iron deficiency anaemia ```

Question 33

Investigations for suspected colorectal cancer

Answer 33

Full blood count (microcytic anaemia) Colonoscopy + biopsy CT for staging

Question 34

Management of colorectal cancer

Answer 34

Surgery - right hemicolectomy for caecal/ascending colon tumours - left hemicolectomy for descending colon tumours - Hartmann's procedure Chemotherapy

Question 35

What is anal caner?

Answer 35

Cancer of anus Majority are squamous cell carcinoma arising below dentate line

Question 36

Risk factors for anal cancer

Answer 36

HPV HIV Smoking Crohn's disease

Question 37

Clinical features of anal cancer

Answer 37

Rectal pain Rectal bleeding Mass on PR

Question 38

Investigations for suspected anal cancer

Answer 38

Proctoscopy | - biopsy if indicated

Question 39

Management of anal cancer

Answer 39

Chemo-radiotherapy is first choice T1N0 - surgical excision