GI Cancers - Oesophageal , Gastric, Colorectal and small intestine Flashcards
What are the types of Oesophageal Cancer
Associated with location:
Lower 1/3 - Adenocarcinoma
(MC in developed world)
- Barret’s complication
Upper 2/3
Squamous cell carcinoma
What are the RF for developing oesophageal cancer
A-F
Achalasia
Barret’s
Corrosive oesophagitis
Diverticulitis
Esophageal Web
Fhx
Presentation of oesophageal cancer
THROAT LUMP
LONG HISTORY OF DYSPEPSIA
ALARMS:
Anaemia
Loss of weight
Anorexia
Recent onset worsening of symptoms
Malena / Hematemesis
Swallowing difficulties: (PROGRESSIVE DYSPHAGIA)
Oesophageal cancer investigations
1st line: Upper GI endoscopy OGD+ biopsy
(REFER WITHIN 2 WEEKS)
Staging: CT scan or endoscopic ultrasound
Oesophageal cancer TX
if fit - surgical excision and chemo -EST
If unfit - palliative
Gastric cancer types
Mostly Adenocarcinoma
Type 1: intestinal/differentiated (70-80%)
Type 2: diffuse/undifferentiated (20%
What are the patterns seen with gastric cancers?
Type 1 - Intestinal /Differentiated
- tumour adhere and arrange in glandular formation appearing as large irregular ulceration with heaped edges. Commonly around the antrum
Type 2: Blood TYPE A young
diffuse/undifferentiated Poorly diffused signet ring cells from gastric lining
Gastric cancer risk factors
Male
H. Pylori
Chronic gastritis
Older age
Criteria for 2 week wait endoscopy in gastric cancer
Upper abdominal mass +
- progressive Dysphagia (any age)
Or
- Aged >55 + weight loss and:
- Upper abdominal pain
- Reflux
- Dyspepsia
Where would gastric cancer MET TO
Liver - Will see jaundice in this
Clinical manifestation of gastric cancer
Often late presentation
nausea/vomiting, weight loss
Severe epigastric pain
Anaemia
Hematemesis
DX of Gastric cancer
Gastroscopy: 8-10 biopsies
(REFER WITHIN 2 WEEKS)
Staging: CT scan or endoscopic ultrasound
TX Gastric Cancer
Surgical resection
Chemo
Whats ECF stand for
ECF is named after the initials of the chemotherapy drugs used. They are:
epirubicin
cisplatin
fluorouracil (usually called 5FU).
ECF is used to treat stomach cancer and oesophageal (gullet) cancer.
Colorectal Cancer RF
Family Hx - younger presentation
IBD
Diet (red meat, low fibre)
Obesity
Colorectal polyps
Smoking
PX of colorectal cancer
commonly cancer of distal colon:
LLQ pain,
fresh bloody mucus stools
tenesmus
Diagnosis of colon cancer
Faecal occult blood FOB test - screens for micro blood in stool
a) >50 + bowel habit change or IRON DEFICIENT ANAEMIA
b) >60 + anaemia
GS - Colonoscopy + biopsy
CT for staging
Staging of colon cancer
Dukes staging system
A) confined to submucosa
B) invasion through muscularis without lymph node involvement
C) invasion through muscularis with lymph node involvement
D) presence of distant metastases
treating colorectal cancer
Surgical resection and chemo
Pathophysiology of colorectal cancers
intially start off as adenoma or polyp precursor which overtime turn into adenocarcinoma most common sigmoid
where does colorectal cancers met to
liver
lung
Example of hereditary causes of colon cancer
Familial adenomatous polyposis (FAP) - AUTOSOMAL DOMINANT
BREAK CARD
Refer patients using a suspected cancer pathway referral for an appointment within 2 weeks if one of the following is present [3]:
≥ 40 years old with unexplained weight loss and abdominal pain or
≥ 50 years old with unexplained rectal bleeding or
≥ 60 years old with iron-deficiency anaemia or changes in bowel habit or
Tests show occult blood in their faeces
ening test [4]:
The screening test detects traces of blood in the stool and,
Testing is offered every 2 years: to all men and women aged 60 to 74 years in England and 50 to 74 years in Scotland
Screening can be requested every 2 years by patients over 74 years old
The two types of test are the Faecal Occult Blood (FOB) test and Faecal Immunochemical Test (FIT) [6]
