GI cancers

Question 1

What are the hallmarks of cancer?

Answer 1

Sustaining proliferative signalling

Evading growth suppressors

Activating invasion and metastasis

Enabling replicative immortality

Inducing angiogenesis

Resisting cell death

Question 2

What is the cancer of squamous epithelium

glandular epithelium?

Answer 2

Squamous Cell Carcinoma (SCC

Adenocarcinoma

Question 3

What is the cancer of enteroendocrine cells

Interstitial cells of cajal?

Answer 3

Neuroendocrine Tumours (NETs)
                    Gastrointestinal Stromal Tumours (GISTs)

Question 4

What is the cancer of
smooth muscle

adipose tissue?

Answer 4

Leiomyoma/leiomyosarcomas

Liposarcomas

Question 5

What diseases are suitable for screening?

Answer 5

Use the Wilson and Jungner criteria

Screening :Testing of asymptomatic individuals to identify cancer at an early stage

Question 6

What screening test is available for Colorectal cancer?

Answer 6

Faecal immunochemical test (FIT) - detects haemoglobin in faeces, every 2 years for everyone aged 60-74

One-off sigmoidoscopy for everyone aged >55 to remove polyps (reducing future risk of cancer).

Question 7

What screening test is available for Oesophageal cancer?

Answer 7

Regular endoscopy to patients with:

• Barrett’s oesophagus
• Low - high-grade dysplasia.

Question 8

What screening test is available for Pancreatic and Gastric cancer?

Answer 8

No test exists that meets the W & J criteria.

Depends on incidence - Japan screens for gastric cancer

Question 9

What screening test is available for Hepatocellular cancer?

Answer 9

Regular ultrasound & AFP for high-risk individuals with cirrhosis

• Viral hepatitis
• Alcoholic hepatitis.

Question 10

Who is part of the cancer MDT ? 7

Answer 10

pathologist
Cancer Nurse specialist
Surgeon
Oncologist
Gastroenterologist 
Palliative care
Radiologist

Question 11

What does a pathologist for for the MDT?

Answer 11

Confirm diagnosis using biopsy samples:

Histologic typing - what cell the cancer comes from

Molecular typing - what mutation does cancer have

Tumour grade - how aggressive is cancer, how abnormal the cells are and how actively they are diving

Question 12

What does a radiologist do for the MDT?

Answer 12

Review scans - to confirm diagnosis or other suspects, where a biopsy should be done

Radiological tumour stage - how far has it spread
TNM system

Provides Re-staging after treatment - did cancer respond to treatment

Interventional radiology - Percutaneous biopsy, stents

Question 13

What is the TNM system?

Answer 13

T - size of tumour
N - lymph node involvement
M - presence of distant metastases

Question 14

Which tumour is more curable
T2N0M0
or
T3N1M1

Answer 14

T2N0M0

Question 15

What does the gastroenterologist do for the MDT?

Answer 15

Endoscopy:

• Upper GI ( Oesophageal & gastric biopsies
  Oesophageal stent )
• liver and pancreas ( ERCP & EUS biopsies
  Biliary stents )
• Lower GI ( Colonic biopsies
  Colonic stents )

Question 16

What does the Oncologist do for the MDT?

Answer 16

Chemo, radio or other systemic is appropriate

Coordinates overall plan

Chemo neoadjuvant or adjuvant to surgery

Type, grade and stage in consideration

Patient fitness and wishes

Decides if plan should be for radical (curative) or palliative therapy or palliative care:

Palliative care
CNS

Question 17

What are the characteristics of Squamous Cell carcinoma?

Answer 17

Upper 2/3
Develops from normal oesophageal squamous epithelium
Commonest in developing world

Question 18

What are the characteristics of Adenocarcinomas?

Answer 18

Lower 1/3 of oesophagus
Squamous epithelium that has become columnar (metaplastic)
Related to acid reflux
Commonest in developed world

occurs in 0.5-1.1% of px with Barretts per year

Question 19

What are the characteristics of Oesophagitis?

Answer 19

Inflammation

Due to GORD

• increases risk of cancer

Question 20

What are the characteristics of Barrett’s Oesophagus?

Answer 20

Intestinal metaplasia

Occurs in 5% of pts with GORD
Metaplasia → mild → moderate → severe dysplasia’ → cancer

• increases risk of cancer

Question 21

What may be the clinical presentation of Oesophageal cancer?

Answer 21

Dysphagia

Late presentation

Significant cancer growth needs to occur before dysphagia (difficulty swallowing).

Often have metastases

Most patients deemed unfit for surgery at diagnosis (malnourished)

• Importance of screening patients with reflux disease or Barrett’s oesophagus

Question 22

What can increase the risk for Gastric Adenocarcinoma?

Answer 22

Things that cause chronic gastritis

• H.pylori infection
  due to chronic acid overproduction
• Pernicious anaemia
  autoantibodies against parts & products of parietal cells
• Partial gastrectomy (e.g. for an ulcer)
  leading to bile reflux
• Epstein-Barr virus infection
• Family history (including heritable diffuse-type gastric cancer due to E-cadherin mutations)

+ High salt diet & smoking

Question 23

What is the common presentation for gastric cancers?

Answer 23

Dyspepsia - upper abdominal pain after eating/drinking

ALARMS55:

A - anaemia
L - Loss of weight
A - abdominal mass on examination
R - recent onset of progessive symptoms
M - Melaenia / haematmesis
S - swallowing difficulty
55 - age and above