GI - Cancers Flashcards
Barrett’s oesophagus is associated with an increased risk of what form of oesophageal cancer?
Adenocarcinoma
The upper 2/3rds of the oesophagus are more likely to have what form of cancer?
Squamous cell carcinoma
What are signet rings a sign of?
Gastric cancer
What part of the stomach is most commonly the site of cancer?
The cardia
What are some symptoms of oesophageal carcinomas?
Progressive dysphagia GORD symptoms Nausea Loss of appetite Hoarse voice Haematemesis Weight loss
What are some of the risk factors for developing oesophageal-gastric carcinomas?
GORD Barrett's oesophagus Alcohol excess Smoking Asian ethnicity H pylori pernicious anaemia Group A blood type Gastric adenomatous polyps
What is the most common type of gastric cancer?
Adenocarcinoma
List some signs / symptoms of gastric cancer?
Anorexia Dyspepsia Dysphagia Epigastric pain Virchow's node (left supraclavicular fossa) Anaemia
How is gastric cancer investigated?
An FBC may reveal anaemia
OGD and biopsy
CT/MRI to stage the disease
What are the main sites of metastasis in gastric cancer?
Liver (48%) Peritoneum Bone Lung Nervous system (seen in cardia cancers)
In gastric cancer when might a subtotal gastrectomy be appropriate?
(Proximally sited disease) When the tumour is 5-10 cm away from the gastroesophageal junction
When would a total gastrectomy be more suitable in gastric carcinomas?
When the tumour is <5 cm from the gastroesophageal junction
What is a common metabolic side effect of a gastrectomy?
Dumping syndrome
What are some of the symptoms of dumping syndrome?
Early: Sweating and fainting after a meal caused by sudden dumping of food in jejunum
Late: Rebound hypoglycemia caused by a surge of insulin in response to dumping of food into intestine
What hereditary syndrome is associated with duodenal and gastric fundic polyps as well as abdominal desmoid tumours?
Familial adenomatous polyposis
What are the tumour markers associated with familial adenomatous polyposis?
APC gene (80% dominant)
How is FAP screened for?
Yearly flexible sigmoidoscopy from age 15. If no polyps by 20 then 5 yearly colonoscopy
All polyps found must be resected
What is the risk of polyps becoming malignant in FAP?
100%
What disease is associated with a mutation of the PTEN gene on the chromosome 10q22?
Cowden’s disease
What type of cancers are associated with cowden’s disease?
Intestinal hamartomas
Multiple trichilemmomas
89% risk of cancer at any site
16% risk of colorectal cancer
What non cancerous health condition is associated with Cowden’s disease?
Macrocephaly
What type of tumours are associated with Petz-Jeugar’s syndrome?
Benign intestinal hamartomas
Increased risk of GI cancers including colorectal and gastric
Also an increased risk of breast ovarian cervical pancreatic and testicular cancers
Peutz Jeghers is associated with what chromosome?
19
What is the mutation associated with Peutz-Jeghers syndrome?
STK11
What is a symptoms associated with Peutz-Jeghers syndrome?
Increased pigmentation
What syndrome is likely to cause right sided, mucinous, colonic cancers?
HNPCC (Lynch syndrome)
What other carcinomas are associated with HNPCC?
Gastric
Endometrial
How is HNPCC monitored?
Colonoscopy every 1-2 years from age 25
Consider prophylactic surgery
Increased colonic surveillance may be required
What non colonic cancers are associated with Cowden’s disease?
Breast (81%)
Thyroid
Uterine
Where are tumours more likely to occur in the colon of someone with MYH associated plyposis?
Right hand side
How is MYH associated polyposis managed?
As soon as it is identified there is a resection and ileoanal pouch reconstruction is the best surgical management.
Regular colonoscopy recommended
What is common tumour marker for colonic cancer?
CEA
What is tumour marker associated with gastric cancer, as well as SCLC and neuroblastomas?
Bombastin
CA-19-9 is a common tumour marker associated with what?
Pancreatic cancer
What tumour marker is raised in hepatocellular carcinoma?
AFP
What form of cancer is the 2nd most common cause of cancer related deaths in the UK?
Colonic carcinomas
How is colonic cancer staged?
Modified Duke’s criteria
Staged A-D
Where are the majority of colonic cancers located?
Sigmoid and rectum
What are some signs/symptoms of disseminated malignancy?
Hepatomegaly
Jaundice
Lymphadenopathy
Obstruction
What are some symptoms of colon malignancy?
PR bleeding Change in bowel habits Weight loss Abdominal mass Tenesmus Anaemia
What would be seen on a FBC of a patient with colonic malignancy?
Decreased Hb
Decreased MCV
How is colonic cancer screened for in the UK?
Ages 60-74 will receive the FIT test every two years (In england)
In scotland its 50-74
Uses faecal occult blood testing
What screening tool for bowel cancer is being used as a once off for people aged 55?
Flexible sigmoidoscopy to look for polyps
Can patients self refer for bowel cancer screening?
Yes anyone aged 55-60 can do so if they have concerns. Eligible for the flexible sigmoidoscopy
What is the most common type of colon cancer?
Adenocarcinoma
How is bowel cancer investigated?
Sigmoidoscopy
Colonoscopy with biopsy
CT scan
(Barium enema may be used)
How is bowel cancer treated?
Surgical resection is the main - curative option
Chemotherapy can be given adjunct
When might it be appropriate to give adjunct radiotherapy in colon cancer
When cancer is in the rectum
What medication is thought to be preventative in cancer and why?
Aspirin >75mg
Reduces likelihood of polyp growth
Ulcerative colitis and PSC lead to an increased risk of what cancer?
Cholangiocarcinoma
Painless jaundice must always be treated as ______ until proven otherwise?
Pancreatic cancer
What is the most common type of anal cancer?
Squamous cell carcinoma
What are the main risk factors for anal cancer?
HPV
Anal sexual intercourse
A patient has symptoms of: recurrent peptic ulcer disease, watery diarrhoea and weight loss What is this triad indicating?
Gastrinoma
What medication can be given to treat a gastrinoma?
Octreotide - a somatostatin synthetic
Why is a somatostatin synthetic used to treat gastrinomas?
Gastrinoma secrete gastrin - somatostatin has an inhibitory effect
