GI cancers Flashcards
What are the hallmarks of cancer?
Sustaining proliferative signalling
Evading growth suppressors
Activating invasion and metastasis
Enabling replicative immortality
Inducing angiogenesis
Resisting cell death
What is the cancer of squamous epithelium
glandular epithelium?
Squamous Cell Carcinoma (SCC
Adenocarcinoma
What is the cancer of enteroendocrine cells
Interstitial cells of cajal?
Neuroendocrine Tumours (NETs)
Gastrointestinal Stromal Tumours (GISTs)What is the cancer of
smooth muscle
adipose tissue?
Leiomyoma/leiomyosarcomas
Liposarcomas
What diseases are suitable for screening?
Use the Wilson and Jungner criteria
Screening :Testing of asymptomatic individuals to identify cancer at an early stage
What screening test is available for Colorectal cancer?
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).
What screening test is available for Oesophageal cancer?
Regular endoscopy to patients with:
- Barrett’s oesophagus
- Low - high-grade dysplasia.
What screening test is available for Pancreatic and Gastric cancer?
No test exists that meets the W & J criteria.
Depends on incidence - Japan screens for gastric cancer
What screening test is available for Hepatocellular cancer?
Regular ultrasound & AFP for high-risk individuals with cirrhosis
- Viral hepatitis
- Alcoholic hepatitis.
Who is part of the cancer MDT ? 7
pathologist Cancer Nurse specialist Surgeon Oncologist Gastroenterologist Palliative care Radiologist
What does a pathologist for for the MDT?
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
What does a radiologist do for the MDT?
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
What is the TNM system?
T - size of tumour
N - lymph node involvement
M - presence of distant metastases
Which tumour is more curable
T2N0M0
or
T3N1M1
T2N0M0
What does the gastroenterologist do for the MDT?
Endoscopy:
- Upper GI ( Oesophageal & gastric biopsies
Oesophageal stent ) - liver and pancreas ( ERCP & EUS biopsies
Biliary stents ) - Lower GI ( Colonic biopsies
Colonic stents )
What does the Oncologist do for the MDT?
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
What are the characteristics of Squamous Cell carcinoma?
Upper 2/3
Develops from normal oesophageal squamous epithelium
Commonest in developing world
What are the characteristics of Adenocarcinomas?
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
What are the characteristics of Oesophagitis?
Inflammation
Due to GORD
- increases risk of cancer
What are the characteristics of Barrett’s Oesophagus?
Intestinal metaplasia
Occurs in 5% of pts with GORD
Metaplasia → mild → moderate → severe dysplasia’ → cancer
- increases risk of cancer
What may be the clinical presentation of Oesophageal cancer?
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
What can increase the risk for Gastric Adenocarcinoma?
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
What is the common presentation for gastric cancers?
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
