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Gastroenterology > GI Cancers > Flashcards

GI Cancers Flashcards

1
Q

define 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

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2
Q

define primary cancer

A

Arising directly from the cells in an organ

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3
Q

define secondary/metastatic cancer

A

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

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4
Q

hallmarks of cancer

A 
resisting cell death
inducing angiogenesis
enabling replicative immortality
activating invasion and metastasis
evading growth suppressors
sustaining proliferative signalling
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5
Q

what four things underlie the hallmarks of cancer?

A

enabling characteristics: genome instability and mutation, tumor-promoting inflammation
emerging hallmarks: deregulating cellular energetics, avoiding immune destruction

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6
Q

cancer of squamous epithelium is called?

A

squamous cell carcinoma

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7
Q

cancer of glandular epithelium is called?

A

adenocarcinoma

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8
Q

cancer of enteroendocrine cells is called?

A

neuroendocrine tumours

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9
Q

cancer of interstitial cells of Cajal is called?

A

gastrointestinal stromal tumours

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10
Q

cancer of smooth muscle is called?

A

leiomyoma/leiomyosarcomas

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11
Q

cancer of adipose tissue is called?

A

liposarcomas

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12
Q

what diseases are suitable for screening? Wilson & Jungner criteria

A

important health problem
should be accepted treatment
available facilities for diagnosis and treatment
recognizable latent / early symptomatic stage
suitable test/exam
test should be acceptable to population
development of disease should be adequately understood

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13
Q

list GI cancers that are screened for

A

colorectal
oesophageal
pancreatic + gastric
hepatocellular

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14
Q

screening for colorectal cancer

A

Offered to healthy individuals:
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)

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15
Q

screening for oesophageal cancer

A

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

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16
Q

screening for hepatocellular cancer

A

Regular ultrasound & AFP for high-risk individuals with cirrhosis
Viral hepatitis
Alcoholic hepatitis

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17
Q

patient’s cancer journey

A

signs and symptoms > diagnosis > staging > surgically removed?/systemic therapy (chemo)/radiotherapy

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18
Q

GI cancer MDT is made up of?

A 
pathologist
cancer nurse specialist
surgeon
radiologist
palliative care
gastroenterologist
oncologist
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19
Q

role of pathologist in GI cancer MDT

A

confirms cancer diagnosis using biopsy samples
provides histologic typing
provides molecular typing
provides tumour grade

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20
Q

role of radiologist in GI cancer MDT

A

reviews scans
provides radiological tumour stage
provides restaging after treatment
interventional radiology

21
Q

role of surgeon in GI cancer MDT

A

decides whether surgery is appropriate

performs operation & cares for patient in perioperative period

22
Q

role of gastroenterologist in GI cancer MDT

A

endoscopy - diagnostic and therapeutic

stents and biopsies

23
Q

role of oncologist in GI cancer MDT

A

Decides on whether chemotherapy, radiotherapy or other systemic therapy is appropriate
Coordinates the overall treatment plan
Should chemotherapy come before surgery (neoadjuvant) or after (adjuvant)?

24
Q

purpose of MDT in cancer care

A

MDT decides whether plan should be for radical (curative) or palliative therapy or palliative care

25
Q

what is the major driver of gastric adenocarcinoma?

A

chronic gastritis

26
Q

causes of gastric adenocarcinoma

A 
H.pylori infection
pernicious anaemia
partial gastrectomy
epstein-barr virus infection
heritable diffuse type gastric cancer
27
Q

how does H.pylori infection lead to gastric cancer?

A

chronic acid overproduction

28
Q

how does pernicious anaemia lead to gastric cancer?

A

autoantibodies against parts & products of parietal cells

29
Q

how does partial gastrectomy lead to gastric cancer?

A

leading to bile reflux

30
Q

what mutations in heritable diffuse type gastric cancer?

A

E-cadherin mutations

31
Q

pathogenesis of gastric cancer

A

chronic gastritis > intestinal metaplasia > dysplasia > malignancy

32
Q

what is the commonest symptom of GI cancer?

A

dyspepsia

33
Q

red flag symptoms for GI cancers

A 
anaemia
loss of weight/appetite
abdominal mass on examination
recent onset of progressive symptoms
melaena or haematemesis
swallowing difficulty
55 years of age or above
34
Q

diagnosis of GI cancer

A

similar to oesophageal cancer: endoscopy + biopsy

35
Q

staging of GI 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

36
Q

treatment options for gastric cancer

A

oesophago-gastrectomy
total gastrectomy
subtotal gastrectomy
neoadjuvant/adjuvant chemotherapy

37
Q

neuroendocrine tumours arise from?

A

Arise from the gastroenteropancreatic (GEP) tract (or bronchopulmonary system)

38
Q

neuroendocrine tumours are associated with _________ in 25% and are __________ in 75%

A

genetic syndrome

sporadic

39
Q

presentation of neuroendocrine tumours

A

most are asymptomatic and incidental
abnormal hormonal secretion
carcinoid syndrome

40
Q

carcinoid syndrome

A 
Vasodilatation
Bronchoconstriction
^ intestinal motility
Endocardial fibrosis (PR & TR)
41
Q

clinical features of insulinoma

A

hypoglycaemia

Whipple’s triad

42
Q

clinical features of glucagonoma

A

diabetes mellitus

necrolytic migratory erythema

43
Q

clinical features of gastrinoma

A

Zollingere-Ellison

44
Q

clinical features of VIPoma

A

Verner-Morrison syndrome

watery diarrhoea

45
Q

clinical features of somatostatinoma

A

gallstones
diabetes mellitus
steatorrhoea

46
Q

diagnosis of neuroendocrine tumours - biochemical assessment

A

Chromogranin A is a secretory product of NETs
Other gut hormones: insulin, gastrin, somatostatin, PPY
Measured in fasting state
Other screening: Calcium, PTH, prolactin, GH
24 hr urinary 5-HIAA (serotonin metabolite)

47
Q

diagnosis of neuroendocrine tumours - imaging

A 
Cross-sectional imaging (CT and/or MRI)
Bowel imaging (endoscopy, barium follow through, capsule endoscopy)
Endoscopic ultrasound
Somatostatin receptor scintigraphy
68Ga-DOTATATE PET/CT most sensitive
48
Q

why is tumour grade useful?

A

provides valuable prognostic information

influences management

49
Q

treatment modalities for NETs

A

curative resection
cytoreductive resection
liver transplantation

Gastroenterology (9 decks)

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