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4th Year Gen Med > GI - Cancers > Flashcards

GI - Cancers Flashcards

1
Q

Barrett’s oesophagus is associated with an increased risk of what form of oesophageal cancer?

A

Adenocarcinoma

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2
Q

The upper 2/3rds of the oesophagus are more likely to have what form of cancer?

A

Squamous cell carcinoma

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3
Q

What are signet rings a sign of?

A

Gastric cancer

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4
Q

What part of the stomach is most commonly the site of cancer?

A

The cardia

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5
Q

What are some symptoms of oesophageal carcinomas?

A 
Progressive dysphagia
GORD symptoms
Nausea
Loss of appetite
Hoarse voice
Haematemesis
Weight loss
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6
Q

What are some of the risk factors for developing oesophageal-gastric carcinomas?

A 
GORD
Barrett's oesophagus
Alcohol excess
Smoking
Asian ethnicity
H pylori
pernicious anaemia
Group A blood type
Gastric adenomatous polyps
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7
Q

What is the most common type of gastric cancer?

A

Adenocarcinoma

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8
Q

List some signs / symptoms of gastric cancer?

A 
Anorexia
Dyspepsia
Dysphagia
Epigastric pain
Virchow's node (left supraclavicular fossa)
Anaemia
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9
Q

How is gastric cancer investigated?

A

An FBC may reveal anaemia
OGD and biopsy
CT/MRI to stage the disease

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10
Q

What are the main sites of metastasis in gastric cancer?

A 
Liver (48%)
Peritoneum
Bone
Lung 
Nervous system (seen in cardia cancers)
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11
Q

In gastric cancer when might a subtotal gastrectomy be appropriate?

A

(Proximally sited disease) When the tumour is 5-10 cm away from the gastroesophageal junction

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12
Q

When would a total gastrectomy be more suitable in gastric carcinomas?

A

When the tumour is <5 cm from the gastroesophageal junction

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13
Q

What is a common metabolic side effect of a gastrectomy?

A

Dumping syndrome

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14
Q

What are some of the symptoms of dumping syndrome?

A

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

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15
Q

What hereditary syndrome is associated with duodenal and gastric fundic polyps as well as abdominal desmoid tumours?

A

Familial adenomatous polyposis

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16
Q

What are the tumour markers associated with familial adenomatous polyposis?

A 
APC gene
(80% dominant)
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17
Q

How is FAP screened for?

A

Yearly flexible sigmoidoscopy from age 15. If no polyps by 20 then 5 yearly colonoscopy
All polyps found must be resected

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18
Q

What is the risk of polyps becoming malignant in FAP?

A

100%

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19
Q

What disease is associated with a mutation of the PTEN gene on the chromosome 10q22?

A

Cowden’s disease

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20
Q

What type of cancers are associated with cowden’s disease?

A

Intestinal hamartomas
Multiple trichilemmomas
89% risk of cancer at any site
16% risk of colorectal cancer

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21
Q

What non cancerous health condition is associated with Cowden’s disease?

A

Macrocephaly

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22
Q

What type of tumours are associated with Petz-Jeugar’s syndrome?

A

Benign intestinal hamartomas
Increased risk of GI cancers including colorectal and gastric
Also an increased risk of breast ovarian cervical pancreatic and testicular cancers

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23
Q

Peutz Jeghers is associated with what chromosome?

A

19

24
Q

What is the mutation associated with Peutz-Jeghers syndrome?

A

STK11

25
Q

What is a symptoms associated with Peutz-Jeghers syndrome?

A

Increased pigmentation

26
Q

What syndrome is likely to cause right sided, mucinous, colonic cancers?

A

HNPCC (Lynch syndrome)

27
Q

What other carcinomas are associated with HNPCC?

A

Gastric

Endometrial

28
Q

How is HNPCC monitored?

A

Colonoscopy every 1-2 years from age 25
Consider prophylactic surgery
Increased colonic surveillance may be required

29
Q

What non colonic cancers are associated with Cowden’s disease?

A

Breast (81%)
Thyroid
Uterine

30
Q

Where are tumours more likely to occur in the colon of someone with MYH associated plyposis?

A

Right hand side

31
Q

How is MYH associated polyposis managed?

A

As soon as it is identified there is a resection and ileoanal pouch reconstruction is the best surgical management.
Regular colonoscopy recommended

32
Q

What is common tumour marker for colonic cancer?

A

CEA

33
Q

What is tumour marker associated with gastric cancer, as well as SCLC and neuroblastomas?

A

Bombastin

34
Q

CA-19-9 is a common tumour marker associated with what?

A

Pancreatic cancer

35
Q

What tumour marker is raised in hepatocellular carcinoma?

A

AFP

36
Q

What form of cancer is the 2nd most common cause of cancer related deaths in the UK?

A

Colonic carcinomas

37
Q

How is colonic cancer staged?

A

Modified Duke’s criteria

Staged A-D

38
Q

Where are the majority of colonic cancers located?

A

Sigmoid and rectum

39
Q

What are some signs/symptoms of disseminated malignancy?

A

Hepatomegaly
Jaundice
Lymphadenopathy
Obstruction

40
Q

What are some symptoms of colon malignancy?

A 
PR bleeding
Change in bowel habits
Weight loss 
Abdominal mass
Tenesmus
Anaemia
41
Q

What would be seen on a FBC of a patient with colonic malignancy?

A

Decreased Hb

Decreased MCV

42
Q

How is colonic cancer screened for in the UK?

A

Ages 60-74 will receive the FIT test every two years (In england)
In scotland its 50-74
Uses faecal occult blood testing

43
Q

What screening tool for bowel cancer is being used as a once off for people aged 55?

A

Flexible sigmoidoscopy to look for polyps

44
Q

Can patients self refer for bowel cancer screening?

A

Yes anyone aged 55-60 can do so if they have concerns. Eligible for the flexible sigmoidoscopy

45
Q

What is the most common type of colon cancer?

A

Adenocarcinoma

46
Q

How is bowel cancer investigated?

A

Sigmoidoscopy
Colonoscopy with biopsy
CT scan
(Barium enema may be used)

47
Q

How is bowel cancer treated?

A

Surgical resection is the main - curative option

Chemotherapy can be given adjunct

48
Q

When might it be appropriate to give adjunct radiotherapy in colon cancer

A

When cancer is in the rectum

49
Q

What medication is thought to be preventative in cancer and why?

A

Aspirin >75mg

Reduces likelihood of polyp growth

50
Q

Ulcerative colitis and PSC lead to an increased risk of what cancer?

A

Cholangiocarcinoma

51
Q

Painless jaundice must always be treated as ______ until proven otherwise?

A

Pancreatic cancer

52
Q

What is the most common type of anal cancer?

A

Squamous cell carcinoma

53
Q

What are the main risk factors for anal cancer?

A

HPV

Anal sexual intercourse

54
Q

A patient has symptoms of: recurrent peptic ulcer disease, watery diarrhoea and weight loss What is this triad indicating?

A

Gastrinoma

55
Q

What medication can be given to treat a gastrinoma?

A

Octreotide - a somatostatin synthetic

56
Q

Why is a somatostatin synthetic used to treat gastrinomas?

A

Gastrinoma secrete gastrin - somatostatin has an inhibitory effect

4th Year Gen Med (10 decks)

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