GI cancers Flashcards
what is cancer
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems”
what is primary cancer
Arising directly from the cells in an organ
secondary
Metastasis
Spread from another organ, directly or by other means (blood or lymph)
The Hallmarks of Cancer
sustained proliferative signalling evading apoptosis activating invasion and metastisis enabling replacative immortality inducing angiogenisis resisting cell death
what are the emerging hallmarks of cancer
deregulating cellular energetics
avoiding immune destrcution
what are enabiling characteristics
genome instability and mutation
tumour promoting inflammation
is cancer genetic
Cancer is a genetic disease
what cancer do squamous cells undergo
Squamous Cell Carcinoma (SCC)
what cancer do glandular epithelium undergo
Adenocarcinoma
Enteroendocrine cells
Neuroendocrine Tumours (NETs)
Interstitial cells of Cajal
Gastrointestinal Stromal Tumours (GISTs)
Smooth muscle
Leiomyoma/leiomyosarcomas
Adipose tissue
Liposarcomas
what is cancer screening
Testing of asymptomatic individuals to identify cancer at an early stage
what is the Wilson & Jungner criteria for screening
1) condition sought should be important
2) accepted treatment for patients with recognised disease
3) facilities for diagnosis and treatment should be made available
4) recognisable latent or early symtomatic stage
5) there should be a suitabel test/examination
6) test should acceptable to popoultion
7) natrual history of the comdition including development from latent to decleared disease
who is offered Colorectal cancer
screening
healthy individuals
what are the 2 tests
Faecal immunochemical test (FIT)
One-off sigmoidoscopy
what is 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).
test for Oesophageal cancer
endoscopy
to who
Regular endoscopy to patients with:
Barrett’s oesophagus
Low - high-grade dysplasia.
Pancreatic & Gastric cancer
test
No test exists that meets the W & J criteria.
how is it done
Depends on incidence - Japan screens for gastric cancer
who gets screened for Hepatocellular cancer
Regular ultrasound & AFP for high-risk individuals with cirrhosis (caused by Viral hepatitis
Alcoholic hepatitis.)
what other genreal category of people get screened
, specific screening programmes exist for individuals with genetic predisposition or strong family histories
what are the stages to a cancer patient
DIAGNOSIS
STAGING
TREATMENT
what is the diagnosis
What symptoms & signs does the patient present with?
How is the diagnosis made?
staging
investigations are needed to see how advanced the cancer is
TREATMENT
Can the cancer be surgically removed?
What systemic therapy (e.g. chemotherapy) or radiotherapy is available?
how are cancer patients treated by
by a cancer MDT
who is part of the MDT
Radiologist Palliative Care Gastroenterologist Oncologist Surgeon Cancer Nurse Specialist (CNS) Pathologist
what does a patholigist do
Confirms the diagnosis of cancer using biopsy samples.
what is the function if histological sampling
Provides histologic typing, i.e. what type of cell does the cancer come from?
what is molecular typing
i.e. what mutations does this cancer have?
Alongside the histological type, this can determine types of treatment available.
what is tumour grade
how aggressive is the cancer?
Determined by how ‘abnormal’ cells & their nuclei are and how actively they are dividing.
how differentiated it is
what do radioligist do
Reviews scans
how are cancers reviewed
The TNM system used.
what does the system stand for
T - size of Tumour.
N - lymph Node involvement
M - presence of distant Metastases.
job of Oncologist
Decides on whether chemotherapy, radiotherapy or other systemic therapy is appropriate.
Coordinates the overall treatment plan
what big desion does the MDT neeed to make
MDT decides whether plan should be for radical (curative) or palliative therapy or palliative care
Palliative care
CNS
what is neoadjivant
chemo before surgery
why neo
big tumour to shrink making surgery easier
high chance of cancer spread
what is adjuvant chemo
after cancer has been taken away
what is considered
Takes into consideration Type, grade & stage Patient fitness (‘performance status’) and wishes.
what is pallative therapy
tring to extend someones life when you know they are going to die from disease
pallative care
letting someone die from disease and don’t treat as more harm then good e,g, cancer too far progressed
what cancers occur on the upper 2/3 of the oesophagus
squmaous cell carcinoma
what does it develop from
Develops from normal oesophageal squamous epithelium
what effects the lower 1/3
Adenocarcinoma
what sort of cancer is it
Squamous epithelium that has become columnar (metaplastic)
what is it caused by
acid reflux
what is the zigzag line
show sthe junction between
The Z line in the esophagus is the term for a faint zig-zag impression at the gastro-esophageal junction that demarcates the transition between the stratified squamous epithelium in the esophagus and the intestinal epithelium of the gastric cardia (the squamocolumnar junction).
stomach and oesophagus
what is oesophagus inflammation called
osephagitis
what is it due to
Gastro Oesophageal Reflux Disease GORD
what can that become
Barrett’s oesophagus
intestinal metaplasia
what is after Barrett’s oesophagus
intestinal metaplasia
Metaplasia → mild → moderate → severe dysplasia’ → cancer
what is the last step
Adenocarcinoma (neoplasia)
how do many oesophageal cancers present
Dysphagia (difficulty swallowing) commonest symptom
how are they presented
Late presentation
what does late presentation mean
65% at an advanced stage when diagnosed → palliative treatment.
as not suitable for potential curative treatment
why are they diagnosed late
Significant cancer growth needs to occur before dysphagia develops (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
how do you assesss the diagnoses or stage of oesphageal cancer
Upper GI endoscopy (Oesohagogastroduodenoscopy, OGD)
how is it done
camera in oesophagus
doen to stomach
then all the way to deuodenum
what happens if you find something
bioposy
how do you stage the cancer
CT of chest & abdomen
PET-CT scan to exclude metastases
Staging laparoscopy
To identify liver & peritoneal metastases
Endoscopic ultrasound
Via oesophagus to clarify depth of invasion & involvement of local lymph nodes
how do you treat oesophageal cancer
first you need to knoe if you will cure or pallative(keeping them alive as long as possible)
is you will cure what would you do
neoadjuavnt chemo and do surgery to remove
and pallative
pallative chemo + steriods + and oesophageal stent
what causes gastric cancer
Gastric adenocarcinoma Chronic gastritis is the major driver Pernicious anaemia H.pylori infection Partial gastrectomy (e.g. for an ulcer) Epstein-Barr virus infection Family history High salt diet & smoking
what’s the a cause of infection
H.pylori
what is H pylori causing
due to chronic acid overproduction
more gastrin release
increase acid and pepsinogen
causing metaplasia of epithelium
Pernicious anaemia
autoantibodies against parts & products of parietal cells
what is Partial gastrectomy (e.g. for an ulcer)
removing a part of the stomach
why dint we do it
as it is secondary to h pylori
treat with antibiotics and proton pump inhibor
what is the problem in poeple with partial g
bile reflux
how does the pathogenisis develop
Chronic gastritis → Intestinal metaplasia → Dysplasia → Malignancy
Presentation of gastric cancer
ALARMS55 Anaemia Loss of weight or appetite Abdominal mass on examination Recent onset of progressive symptoms Melaena or haematemesis Swallowing difficulty 55 years of age or above
what is the most common symptom
Dyspepsia (upper abdominal discomfort after eating or drinking) commonest symptom
how do you diagnose
- similar to oesophageal cancer: endoscopy + biopsy
how do you stage
CT of the chest, abdomen & pelvis will provide information on distant lesions
PET-CT
Diagnostic laparoscopy - peritoneal & liver metastases disease prior to full operation
Endoscopic ultrasound - will give most detail about local invasion & node involvement
how do you treat
neoadjuvant chemo
why neo
as you can shrink the size of the tumour
