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BRS Gastroenterology > GI Cancers > Flashcards

GI Cancers Flashcards

1
Q

What does a ‘primary’ cancer mean?

A

Cancer arising from cells in an organ

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2
Q

What does ‘secondary/metastasis’ mean when referring to cancers?

A

Spread from another organ, directly or by other means (blood, lymph)

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3
Q

What are the 6 hallmarks of cancer?

A 
Sustaining proliferative signalling
Evading growth suppressors
Activating invasion and metastasis
Resisting cell death
Inducing angiogenesis
Enabling replicative immortality
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4
Q

What are the 2 ‘emerging’ and 2 ‘enabling’ hallmarks?

A

Deregulating cellular energetics
Avoiding immune destruction

Tumour-promoting inflammation
Genome instability and mutation

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5
Q

What cells are involved in Squamous Cell Carcinoma and Adenocarcinomas respectively?

A

Squamous cells

“Glandular epithelium”

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6
Q

What cells are involved in Neuroendocrine Tumours and Gastrointestinal Stromal Tumours respectively?

A

Enteroendocrine cells

Interstitial cells of Cajal

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7
Q

What cells are involved in Leiomyomas and Liposarcomas respectively?

A

Smooth muscle

Adipose tissue

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8
Q

What is the most common cancer type in women?

A

Breast cancer

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9
Q

What is the most common cancer type in men?

A

Prostate

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10
Q

What is the most common cause of cancer deaths in the UK, 2018?

A

Lung cancer

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11
Q

What is meant by a Cancer of Unknown Primary?

A

Cancer where there is metastasis but you never find out where the primary has come from.

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12
Q

Do pancreatic cancers tend to metastasise early?

A

Yes

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13
Q

Which GI cancer has the largest overall 5-year survival rate?

A

60% - Colorectal cancer

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14
Q

What are the 7 Wilson & Jungner criteria for cancer screening?

A

Condition sought should be an important health problem.
Accepted treatment should exist.
Facilitated for diagnosis and treatment should be available.
Recognisable latent or early symptomatic stage.
Suitable test/examination.
Test acceptable to the population.
Natural history of the condition including development from latent to declared disease should be adequately understood.

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15
Q

What are the 2 screening methods for colorectal cancer?

A

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

One-off sigmoidoscopy - for everyone aged >55 to remove polyps

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16
Q

How would you screen for oesophageal cancer?

A

Regular endoscopy to patients with:
Barett’s oesophagus
Low-high grade dysplasia

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17
Q

How would you screen for pancreatic and gastric cancer?

A

No test exists that meets the W & J criteria

Depends on incidence - Japan screens for gastric cancer

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18
Q

What criteria do you use to determine which diseases are suitable for screening?

A

Wilson and Junger Criteria

Depends on the epidemiology of a disease and features of the test.

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19
Q

How would you screen for a hepatocellular cancer?

A

Regular ultrasound and AFP for high risk individuals with cirrhosis:
Viral hepatitis (B or C)
Alcoholic hepatitis

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20
Q

What protein is produced in a high % in patients with hepatocellular cancer?

A

AFP (alpha feto protein)

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21
Q

Do specific cancer screening programmes for people with genetic predispositions or strong family histories exist?

A

Yes

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22
Q

What are the 3 main stages in a patient’s cancer journey?

A

Diagnosis - symptoms + signs + how is diagnosis made?

Staging - investigations to see how advanced cancer is.

Treatment - surgery?, is systemic therapy or radiotherapy available?

23
Q

How long after a patient mentions worrying cancer symptoms to their GP or doctor OR is identified to have cancer through a screening programme does the patient have to wait to be seen?

A

Patients has to be seen and investigated within 2 weeks.

24
Q

List members of the cancer MDT.

A 
Pathologist 
Radiologist 
Palliative care 
Gastroenterologist 
Oncologist 
Cancer Nurse Specialist 
Surgeon
25
Q

What does a pathologist do as part of the cancer MDT?

A

Confirms diagnosis of cancer using biopsy samples.

Provides histologic typing, i.e. what type of cell does the cancer come from?
Epithelium (squamous cell carcinoma) or secretory cells (adenocarcinoma).

Provides molecular typing, i.e. what mutations does cancer have?
Alongside the histological type, this can determine types of treatment available.

Provides the tumour grade.
Determined by how ‘abnormal’ cells & their nuclei are and how actively they are dividing.

26
Q

What does a radiologist do as part of the cancer MDT?

A

Reviews scans:
If diagnosis is unclear, comments on how likely the scan is to confirm cancer.
Suggests other imaging to clarify suspected diagnosis
Should a biopsy be performed and from where?

Provides radiological tumour stage.
The TNM system used.
A T2N0M0 tumour may be totally curable, but a T3N1M1 may not be.

Provides re-staging after treatment.
Did the cancer respond completely or partially?
Has it remained stable or progressed?

Interventional Radiology:
Percutaneous biopsies.
Radiological stents.

27
Q

What does a surgeon do as part of the cancer MDT?

A

Decides whether surgery is appropriate.
Is tumour resectable + patient fit enough for surgery?

Performs operation & cares for patient in perioperative period

28
Q

What does a gastroenterologist do as part of the cancer MDT?

A

Endoscopy – diagnostic & therapeutic:
Upper GI - Oesophageal, gastric biopsies and oesophageal stents
Liver & pancreas - ERCP & EUS biopsies + Biliary stents
Lower GI - Colonic biopsies + Colonic stents

29
Q

What does an oncologist do as part of the cancer MDT?

A

Decides on whether chemotherapy, radiotherapy or other systemic therapy is appropriate.
Determined by the scans, histological and molecular type. Is the patient fit for full intensity therapy?
Coordinates the overall treatment plan.
Should chemotherapy come before surgery (neoadjuvant) or after (adjuvant)?
Takes into consideration type, grade & stage + Patient fitness (‘performance status’) and wishes.

MDT decides whether plan should be for radical (curative) or palliative therapy or palliative care
Palliative care
Cancer Nurse Specialist

30
Q

Oesophageal cancer - squamous cell carcinoma

A

Upper 2/3 of oesophagus

Develops from normal oesophageal squamous epithelium

31
Q

What is the commonest oesophageal cancer in the developing world?

A

Squamous cell carcinoma

32
Q

Outline the pathogenesis of an adenocarcinoma.

A

Metaplastic columnar epithelium arising from lower 1/3 of oesophagus, associated to acid reflux, whereby metaplastic mechanism causes squamous cells to be converted into columnar cells → Dysplasia → Adenocarcinoma.

33
Q

What is the epidemiology of adenocarcinoma?

A

More developed world, 9th most common cancer, affects elderly.

M:F = 10:1

34
Q

What causes oesophagitis?

What % of UK population does it affect?

A

GORD

30%

35
Q

What % of patients with GORD develop Barrett’s Oesophagus?

A

5%

Metaplasia > Mild > Moderate > severe > Cancer

36
Q

What % of patients with BO develop an adenocarcinoma?

A

Occurs in 0.5-11% patients with Barrett’s per year.

37
Q

What is the commonest symptom of oesophageal cancer?

A

Dysphagia (difficulty swallowing)

38
Q

Why do 65% of patients with oesophageal cancer present at an advanced stage

A

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)

39
Q

How can you diagnose an oesophageal cancer?

A

Upper GI endoscopy (Oesohagogastroduodenoscopy, OGD)

If lesion is found → biopsy taken to confirm the diagnosis.

40
Q

List investigations used to stage an oesophageal cancer?

A

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.

41
Q

Outline how the treatment option for an oesophageal cancer is made by the cancer MDT.

A

Is tumour surgically resectable with no distant metastases + is patient fit for major surgery?

Yes for both > CURATIVE > Neo-adjuvant (pre-surgery) chemotherapy > Oesophagectomy

No for even 1 > PALLIATIVE > palliative chemotherapy + steroids (dexamethasone) + stent

42
Q

List the causes+pathogenesis of a gastric adenocarcinoma (cancer).

A

Chronic gastritis is the major driver:

  • H.pylori infection due to chronic acid overproduction.
  • Pernicious anaemia autoaAbs against parts & products of parietal cells
  • Partial gastrectomy (e.g. for an ulcer) leading to bile reflux
  • EBV

Family history (including heritable diffuse-type gastric cancer due to E-cadherin mutations)

High salt diet & smoking - never that strong of a cause.

43
Q

Outline the basic pathogenesis of a gastric cancer.

A

Chronic gastritis > intestinal metaplasia > Dysplasia > Malignancy

44
Q

What is the most commonest symptom for a gastric cancer?

A

Dyspepsia (upper abdominal discomfort after eating or drinking)

45
Q

What are the red flags indicating a patient may have gastric cancer?

A

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
46
Q

How do you diagnose a gastric cancer?

A

Endoscopy + biopsy

47
Q

How can you stage a gastric cancer?

A

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.

48
Q

What is the purpose of neo-adjuvant chemotherapy?

A

Reduce tumour size before surgery.

49
Q

How could you treat a tumour at the oesophago-gastric junction?

A

Oesophago-gastrectomy

50
Q

How could you treat a tumour close(<5cm) to the OG junction?

A

Total gastrectomy (can’t save sphincter mechanism)

51
Q

How could you treat a tumour far (>5cm) from the OG junction?

A

Subtotal gastrectomy

52
Q

Purpose of adjuvant chemotherapy in treatment of gastric cancers?

A

May be needed in advanced tumours to reduce risk of relapse.

53
Q

Palliative approaches to treating gastric cancer?

A

Stenting or gastro-jejunal anastomosis.

BRS Gastroenterology (11 decks)

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