GI Cancers Flashcards
Most common type of pancreatic cancer
Ductal carcinoma
Risk factors for pancreatic cancer
60+ Males Family history Diabetes mellitus Chronic pancreatitis
Clinical presentation of pancreatic cancer
Normally asymptomatc
Head of pancreas
- obstructive jaundice
- abdominal pain
- weight loss
What is Courvoisier’s sign?
Painless jaundice + enlarged gallbladder
Pancreatic neoplasm until proven otherwise
What is Trousseau sign of malignancy?
Medical sign involving episodes of vessel inflammation due to recurrent blood clots
Syndrome associated with pancreatic cancer
Investigations for suspected pancreatic cancer
CT
ERCP
Tumour markers
- CA19-9
- CEA
Management of pancreatic cancer
Radical resection- T1-2N0M0
remove pancreas head, antrum of stomach, 1st+2nd parts duodenum, CBD, gall bladder
Adjuvant chemotherapy
Adjuvant radiotherapy
What is the Cochrane review?
Pancreatic resection increases survival and reduces costs compared to palliative treatment
What is hepatocellulatr carcinoma?
Primary liver cancer
Associated with chronic inflammatory proceses affected the liver
Risk factors of hepatocellular carcinoma
Hep B Hep C High alcohol intake Aflatoxin Smoking
Clinical features of hepatocellular carcinoma
Dull upper abdo pain
Enlarged liver
Weight loss
Ascites
Investigations for suspected hepatocellular carcinoma
LFTs
AFP - raised in 80% of cases
Ultrasound
CT
DO NOT BIOPSY
Management of hepatocellular carcinoma
Surgical resection
Common sites for liver metastases to come from
Bowel Breast Stomach Pancreas Lung
What is cholangiocarcinoma?
Cancer of the biliary system
Common site = bifurcation of right and left hepatic ducts
Commonly adenocarcinomas
Risk factors for cholangiocarcinoma
Primary sclerosing cholangitis
Ulcerative colitis
Infective (HIV, hepatitis)
Diabetes mellitus
Clinical features of cholangiocarcinoma
Asymptomatic until late stage
Jaundice
Weight loss
Pruritus
Investigations for suspected cholangiocarcinoma
Bloods - test for obstructive jaundice
Tumour markers - CA19-9
MRCP
Management of cholangiocarcinoma
Surgical resection
PAliative stenting of bile duct
Types of oesphageal cancer
Squamous cell carcinoma
- middle/upper thirds
- associated with smoking/alcohol consumption
Adenocarcinoma
- lower third
- consequence of Barrett’s oesophagus
- risk factor = GORD
Clinical features of oesphageal cancer
Dysphagia - progressive solids to liquids
Significant weight loss
Dyspepsia
Investigations for suspected oesphageal cancer
Endoscopy
Management for oesphageal cancer
Mostly palliative
Risk factors for gastric cancer
Male
H.pylori infection
Increasing age
Smoking
Clinical features of gastric cancer
Dyspepsia
Dysphagia
Early satiety
Possibility of epigastric mass
Investigations for suspected gastric cancer
Endoscopy
- biopsy
CT for staging
Management of gastric cancer
Gastrectomy
- total for proximal tumour
- subtotal for distal tumour
Nutritional assessment
Peri-operative chemotherapy
What is colorectal cancer?
Cancer affecting large bowel
50% affect rectum + left colon
Majority arise from adenomatous polyps
How do colorectal cancers spread?
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
Risk factors for colorectal cancers
Genetic
- lynch syndrome
- FAP
Diet
- alcohol
- red meat
- obesity
Predisposing conditions
- IBD
- previous abdo surgery
Clinical features of right sided colon cancer
Abdominal pain Occult bleeding Mass in RIF Change in bowel habits Iron deficiency anaemia
Clinical features of left sided colon cancer
Changes in bowel habits Rectal bleeding Tenesmus Mass in LIF Iron deficiency anaemia
Investigations for suspected colorectal cancer
Full blood count (microcytic anaemia)
Colonoscopy + biopsy
CT for staging
Management of colorectal cancer
Surgery
- right hemicolectomy for caecal/ascending colon tumours
- left hemicolectomy for descending colon tumours
- Hartmann’s procedure
Chemotherapy
What is anal caner?
Cancer of anus
Majority are squamous cell carcinoma arising below dentate line
Risk factors for anal cancer
HPV
HIV
Smoking
Crohn’s disease
Clinical features of anal cancer
Rectal pain
Rectal bleeding
Mass on PR
Investigations for suspected anal cancer
Proctoscopy
- biopsy if indicated
Management of anal cancer
Chemo-radiotherapy is first choice
T1N0 - surgical excision
