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Gastroenterology > GI Cancers > Flashcards

GI Cancers Flashcards

1
Q

What are cancers involving epithelial cells called?

A

Squamous Cell Carcinoma (SCC) Adenocarcinoma

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2
Q

What are cancers involving neuroendocrine cells called?

A 
Neuroendocrine Tumours (NETs)
Gastrointestinal Stromal Tumours (GISTs)
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3
Q

Give example of neuroendocrine cells of the GI tract

A

Enterocendocrine cells

Interstitial cells of Cajal

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4
Q

What are cancer involving connective tissues called?

A

Leiomyoma/leiomyosarcomas

Adipose tissue Liposarcomas

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5
Q

What are the three parts of the oesophagus?

A

Cervical
Middle
Lower

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6
Q

What are the two types of oesophageal cancer?

A

Squamous cell carcinoma

Adenocarcinoma

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7
Q

What are the main features of squamous cell carcinoma?

A

From normal oesophageal squamous epithelium
Upper 2/3
Acetaldehyde pathway
Less developed world

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8
Q

What are the main features of adenocarcinoma?

A

From metaplastic columnar epithelium
Lower 1/3 of oesophagus
Related to acid reflux
More developed world

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9
Q

What leads to adenocarcinoma?

A

Oesophagitis (inflammation)
Barrett’s (metaplasia)
Adenocarcinoma (neoplasia)

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10
Q

What is the guidelines for Barrett’s surveillance?

A

No dysplasia → Every 2-3 years
LGD → every 6 months
HGD → intervention

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11
Q

What is LGD and HGD?

A

Low/High Grade dysplasia

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12
Q

Who is most affected by oesophageal cancer?

A

Elderly males

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13
Q

What are common facts about OG cancer?

A 
Late presentation
65% palliative
High morbidity & complex surgery
Poor 5-year survival <20%
Palliation- difficult
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14
Q

What are the diagnostic methods for OG cancer?

A

Endoscopy and biopsy

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15
Q

What occurs after diagnosis?

A

Staging
CT Scan (chest, abdo and pelvis)
Laparoscopy (imaging with air, to look for smaller growths)
PET Scan?

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16
Q

What are the treatment options?

A

Curative:
Neo-adjuvant chemo (pre-surgery)
Radical Surgery

Palliative:
Chemo
Stent
DXT

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17
Q

How is a oesophagectomy performed?

A

Divide stomach
Divde oesophagus
Connect

OR

Two-stage Ivor Lewis approach

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18
Q

What are the main features for colorectal cancer?

A

Most common GI cancer in Western Societies
Third most common cancer death in men & women
Appendicitis is 8.6% M vs. 6.7% F

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19
Q

What is the lifetime risk for colorectal cancer?

A

Lifetime risk
1 in 10 for men
1 in 14 for women

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20
Q

Who is generally affected with colorectal cancer?

A

Generally affect patients > 50 years (>90% of cases)

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21
Q

What are the different forms of colorectal cancer?

A

Sporadic
Familial (1st degree)
Hereditary syndrome

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22
Q

What are the features of sporadic colorectal cancer?

A

Absence of family history, older population, isolated lesion

23
Q

What are the features of familial colorectal cancer?

A

Family history, higher risk if index case is young (<50years) and the relative is close (1st degree

24
Q

What are the features of hereditary colorectal cancer?

A

Family history, younger age of onset, specific gene defects

e.g. Familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal cancer (HNPCC or Lynch syndrome)

25
Q

How do polyps form and become cancer?

A

Normal epithelium genetic mutation
hyperprolifertive small polyp
Series of other mutations
Polyp becomes cancer over few years

26
Q

What are the risk factors of colorectal cancer?

A 
Past history 
Colorectal cancer
Adenoma, ulcerative colitis, radiotherapy
Family history 
1st degree relative < 55 yrs
Relatives with identified genetic predisposition
(e.g. FAP, HNPCC, Peutz-Jegher’s syndrome)
Diet/Environmental 
?carcinogenic foods 
Smoking
Obesity
Socioeconomic status
27
Q

What does clinical presentation depend upon?

A

Location
⅔ in descending colon and rectum
½ in sigmoid colon and rectum (i.e. within reach of flexible sigmoidoscopy)

28
Q

How does caecal and right-sided cancer present?

A 
Iron deficiency anaemia (most common)
Change of bowel habit (diarrhoea)
Distal ileum obstruction (late)
Palpable mass (late)
29
Q

How does left sided & sigmoid carcinoma present?

A 
PR bleeding, mucus
Thin stool (late)
30
Q

How does rectal carcinoma present?

A

PR bleeding, mucus
Tenesmus (urgency to defacate constantly)
Anal, perineal, sacral pain (late)

31
Q

What would you do when consulting a patient with suspected colorectal cancer?

A

Ask them about their bowel habits?

Examine abdomen for any palpable masses

32
Q

How would local invasion in the pelvis present?

A

Bladder symtoms

Female genital tract symptoms

33
Q

How might metastatic colorectal cancer present?

A 
Liver (hepatic pain, jaundice)
Lung (cough)
Regional lymph nodes
Peritoneum 
Sister Mary Joseph nodule (growth in umbilicus)
Hepatomegaly (mets)
Monophonic wheeze
Bone pain
34
Q

What are the signs of primary colorectal cancer?

A

Abdominal mass
DRE: most <12cm dentate and reached by examining finger
Rigid sigmoidoscopy
Abdominal tenderness and distension – large bowel obstruction

35
Q

What investigations could you do when diagnosing colorectal cancer?

A

Historically, barium enema

Colonoscopy now

36
Q

Describe colonoscopy

A

Can visualize lesions < 5mm
Small polyps can be removed
Reduced cancer incidence
Usually performed under sedation

37
Q

Describe CT colonoscopy

A 
Can visualize lesions > 5mm
No need for sedation
Less invasive, better tolerated
If lesions identified patient needs colonoscopy for diagnosis
Very detailed
38
Q

What dictates which parts of the colon can be removeD?

A

Blood supply

39
Q

Describe the epidemiology of pancreatic cancer

A

Commonest form of panc CA is pancreatic ductal adenocarcinoma (PDA)

80-85% have late presentation

15-20% have resectable disease

Incidence & mortality roughly equivalent

40
Q

Why is pancreatic cancer so difficult to diagnose?

A

No unique diagnostic features

41
Q

What are risk factors for pancreatic cancer?

A

Chronic pancreatitis
Type II diabetes mellitus
Cigarette smoking
Family history

42
Q

What syndrome results in a high risk of PDA?

A 
Hereditary pancreatitis 
40% chance 
Genes:
PRSS1
SPINK1
CFTR
43
Q

Describe the pathogenesis of pancreatic cancer

A

PDAs evolve through non-invasive neoplastic precursor lesions
PanINs are microscopic (<5 mm diameter) & not visible by pancreatic imaging
Acquire clonally selected genetic & epigenetic alterations along the way

44
Q

How does pancreatic cancer present clinically (head)?

A 
Jaundice (compression of CBD)
Weight loss
Pain (epigastrium radiated to back) 
Acute pancreatitis (unusual)
Gastrointestinal bleeding (unusual)
45
Q

How does carcinoma of the body of tail and pancreas present?

A 
Asymptomatic in early stages
Weight loss
Back pain
Vomiting in late stages 
Most are unresectable at the time of diagnosis
46
Q

What are the diagnostic methods for pancreatic cancer?

A

Tumor marker CA19-9

Ultrasonography

Dual-phase CT

MRI/MRCP/ERCP/EUS

PET

47
Q

How do you treat pancreatic cancer surgically?

A

HOP resection
Join stomach to pancreas and bile duct

If in tail: remove affected area

48
Q

What is HCC

A

Hepatocellular carcinome

49
Q

What are risk factors for HCC?

A

Cirrhosis

Hep B

50
Q

What is the best way to treat HCC?

A

Liver transplant

51
Q

What is ChCA?

A

Cholangiocarcinoma
poor prognosis
<5% at 5 years

52
Q

What causes ChCA?

A

PSC and UC
Liver fluke
Choledochal cyst

53
Q

What causes gallbladder cancer?

A

GS
porcelain GB
Chronic typhoid infection

Gastroenterology (12 decks)

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