GI Cancers tutorial

Question 1

Abdominal causes of dysphagia?

Answer 1

Upper dysphagia
-structural causes:Pharyngeal cancer, pharyngeal pouch
-neurological causes: Parkinson’s, stroke, motor neuron disease

Lower dysphagia
-structural causes:
Inside (mural and luminal): oesophageal or gastric cancer, stricture, Schatzki ring
Outside (extrinsic compression): lung cancer

-neurological causes:Achalasia, diffuse oesophageal spasm

Question 2

Cardiac causes of dysphagia

Answer 2

Post-prandial angina

Question 3

Other than abdominal and cardiac causes, what else could lead to dysphagia

Answer 3

Globus sensation/anxiety

Question 4

What could exacerbate cardiac pain?

Answer 4

Angina can occur after meals (blood shifts to bowel for digestion, limiting blood supply through narrowed coronaries).
However, history of discomfort seconds after swallowing is inconsistent
Unusual for angina to occur only after eating: ask about exertional chest pain.

Question 5

What questions could help determine if dysphagia is of oesophageal origin?

Answer 5

Is food painful on swallowing? (upper)
Is food easy to swallow but feels stuck seconds later? (lower)

Question 6

What question could help determine if the cause of dysphagia is mechanical or neurological?

Answer 6

Are both solids and liquids hard to swallow (likely neurological)

Question 7

If a mechanical cause, how would you determine if the patient at risk of strictures?

Answer 7

Ask about history of reflux

Question 8

Is there blood in stool that the patient has not noticed? What would this suggest? What should be done?

Answer 8

Would suggest a GI malignancy.
Perform a digital rectal examination.

Question 9

What investigations would you request to determine cause of dysphagia?

Answer 9

Bedside: ECG (are there signs of cardiac ischaemia?)
Blood tests: Full blood count (iron deficiency anaemia from chronic GI bleed?), urea and electrolytes (dehydration from poor oral intake?)
Imaging: CXR
Microbiology
Special/invasive: upper GI endoscopy (see: 2 week wait suspected cancer pathway)

Question 10

What will the Upper GI MDT need to consider when deciding the treatment approach for oesophageal adenoma?

Answer 10

Staging CT CAP
PET Scan
Staging laparoscopy

Question 11

How do we TNM stage a cancer?

Answer 11

Question 12

What scale do we use to determine if surgery is right for a patient?

Answer 12

Question 13

Causes of microcytic anaemia (MCV<80)

Answer 13

1. Iron deficiency anaemia
2. Anaemia of chronic disease
3. Thalassaemia
4. Sideroblastic anaemia

Question 14

Causes of normocytic (80-96)
anaemia

Answer 14

Aplastic anaemia
Bleeding
Chronic disease
Destruction (haemolysis)

Endocrine disorders-Hypothyroidism, hypoadrenalism

(ABCDE)

Question 15

Causes of macrocytic (MCV>96)
anaemia

Answer 15

FAT RBC
Foetus (pregnancy)
Alcohol excess
Thyroid disorders
Reticulocytosis
B12/Folate deficiency
Cirrhosis

Question 16

Causes of iron deficiency anaemia

Answer 16

Blood loss
Increased demand (growth, pregnancy)
Decreased absorption

GI causes of IDA in order of frequency
Aspirin/NSAID use
2. Colonic adenocarcinoma
3. Gastric carcinoma
4. Benign gastric ulcer
5. Angiodysplasia
6. Coeliac disease
7. Gastrectomy (decreased absorption)
8. H.pylori

Non-GI causes in order of frequency
1. Menstruation
2. Blood donation
3. Haematuria (1% of iron deficiency anaemias)
4. Epistaxis

Question 17

What kinds of overt bleeding can indicate cancer?

What other symptoms could indicate malignancy?

Answer 17

Blood in stool
Haematuria
Epistaxis
Haemoptysis

Weight loss, anorexia, malaise

Question 18

Symptoms that might suggest colorectal cancer?

Answer 18

Change in bowel habit
Blood or mucus in stool
Faecal incontinence
Feeling of incomplete emptying of bowels (tenesmus)

Question 19

Symptoms that might suggest an upper GI cancer?

Answer 19

Dysphagia
Dyspepsia

Question 20

How do you test for blood in the stool or urine that the patient has not noticed?

Answer 20

Perform a digital rectal examination.
Dip the urine to check for blood.