GI Cancers - Oesophageal , Gastric, Colorectal and small intestine

Question 1

What are the types of Oesophageal Cancer

Answer 1

Associated with location:

Lower 1/3 - Adenocarcinoma
(MC in developed world)
- Barret’s complication

Upper 2/3
Squamous cell carcinoma

Question 2

What are the RF for developing oesophageal cancer

Answer 2

A-F
Achalasia
Barret’s
Corrosive oesophagitis
Diverticulitis
Esophageal Web
Fhx

Question 3

Presentation of oesophageal cancer

Answer 3

THROAT LUMP
LONG HISTORY OF DYSPEPSIA

ALARMS:

Anaemia
Loss of weight
Anorexia
Recent onset worsening of symptoms
Malena / Hematemesis
Swallowing difficulties: (PROGRESSIVE DYSPHAGIA)

Question 4

Oesophageal cancer investigations

Answer 4

1st line: Upper GI endoscopy OGD+ biopsy
(REFER WITHIN 2 WEEKS)

Staging: CT scan or endoscopic ultrasound

Question 5

Oesophageal cancer TX

Answer 5

if fit - surgical excision and chemo -EST

If unfit - palliative

Question 6

Gastric cancer types

Answer 6

Mostly Adenocarcinoma

Type 1: intestinal/differentiated (70-80%)

Type 2: diffuse/undifferentiated (20%

Question 7

What are the patterns seen with gastric cancers?

Answer 7

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

Question 8

Gastric cancer risk factors

Answer 8

Male
H. Pylori
Chronic gastritis
Older age

Question 9

Criteria for 2 week wait endoscopy in gastric cancer

Answer 9

Upper abdominal mass +
- progressive Dysphagia (any age)
Or
- Aged >55 + weight loss and:
- Upper abdominal pain
- Reflux
- Dyspepsia

Question 10

Where would gastric cancer MET TO

Answer 10

Liver - Will see jaundice in this

Question 11

Clinical manifestation of gastric cancer

Answer 11

Often late presentation
nausea/vomiting, weight loss
Severe epigastric pain
Anaemia
Hematemesis

Question 12

DX of Gastric cancer

Answer 12

Gastroscopy: 8-10 biopsies
(REFER WITHIN 2 WEEKS)

Staging: CT scan or endoscopic ultrasound

Question 13

TX Gastric Cancer

Answer 13

Surgical resection
Chemo

Question 14

Whats ECF stand for

Answer 14

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.

Question 15

Colorectal Cancer RF

Answer 15

Family Hx - younger presentation
IBD
Diet (red meat, low fibre)
Obesity
Colorectal polyps
Smoking

Question 16

PX of colorectal cancer

Answer 16

commonly cancer of distal colon:

LLQ pain,
fresh bloody mucus stools
tenesmus

Question 17

Diagnosis of colon cancer

Answer 17

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

Question 18

Staging of colon cancer

Answer 18

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

Question 19

treating colorectal cancer

Answer 19

Surgical resection and chemo

Question 20

Pathophysiology of colorectal cancers

Answer 20

intially start off as adenoma or polyp precursor which overtime turn into adenocarcinoma most common sigmoid

Question 21

where does colorectal cancers met to

Answer 21

liver
lung

Question 22

Example of hereditary causes of colon cancer

Answer 22

Familial adenomatous polyposis (FAP) - AUTOSOMAL DOMINANT

Question 23

BREAK CARD
Refer patients using a suspected cancer pathway referral for an appointment within 2 weeks if one of the following is present [3]:

Answer 23

≥ 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]