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GI malignancies Flashcards

1
Q

How common are GI malignancies?

A

3rd most common cancer in UK

  • bowel
  • pancreas
  • oesophagus
  • stomach
  • liver
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2
Q

What is dysphagia?

A

difficulty swallowing

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3
Q

What are the 3 causes of dysphagia (broadly)

A
  • extra-luminal (due to compression by lungs or hearts)
  • luminal - benign (foreign body)
  • intra-luminal
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4
Q

What are the red flags for someone presenting with dysphagia?

A 
A - anaemia (blood loss in malignancy
L - loss of weight unintentional
A - anorexia (loss of appetite)
R - recent onset of progressive symptoms
M - masses and malaena
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5
Q

What types of oesophageal carcinoma’s are there?

A

-linked to epithelia type

SQUAMOUS CELL CARCINOMA - stratified squamous epithelium in the oesophagus

ADENOCARCINOMA - else where in the GI tract although can develop this in lower oesophagus (barret’s)

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6
Q

What are the risk factors for oesophageal carcinoma?

A
  • smoking
  • barrets
  • GORD
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7
Q

What is the prognosis of oesophageal squamous cell carcinoma?

A

5% survival at 5 years

very poor

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8
Q

How can you diagnose oesophageal carcinoma?

A

barium swallow and X-ray - look at latency of the oesopahgus OR OGD and look at the epithelial lining and take a biopsy

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9
Q

What is another symptoms of Upper GI malignancy’s?

A

epigastric pain

causes can be;

  • eophagitis,
  • peptic ulcer
  • perforated ulcer
  • pancreatitis
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10
Q

What are the red flags for epigastric pain?

A
  • malaena (altered blood coming from upper GI tract)

- Haematemesis - vomitin blood

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11
Q

What are some other causes of upper GI bleeding?

A 
oesophageal varicies
gastric ulcer
duodenal ulcer
acute gastritis
carcinoma of the stomach
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12
Q

Where is the most common site fr gastric cancer?

A

-cardia or antrum

due to the type of epithelium there, adenocarcinomas are more common

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13
Q

How would patients present?

A
  • epigastric pain
  • symptoms similar to peptic ulcer
  • palpable mass
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14
Q

What are the risk factors for gastric cancer?

A
  • smoking
  • high salt diet
  • fam history
  • H/pylori (risk factor for gastric ulcers too)
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15
Q

NOTE

A

in general, chronic inflammation puts you at higher risk of malignancy

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16
Q

What is the prognosis for gastric cancer?

A

generally quite poor
-10% 5 year survival
50% after curative surgery

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17
Q

Why do we not screen gastric cancer in the UK?

A

prevalence is low in UK

screwing occurs in japan due to high salt diet and higher prevalence

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18
Q

What is gastric lymphoma?

A
  • MALT tissues
  • similar presentation to gastric carcinoma
  • most associated with H.Pylori
  • prognosis better than gastric cancer due to the type of tissue associated with it
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19
Q

What is GIST’s?

A

Gastro Intestinal Stromal Tumors
(soft tissue)
-sarcomas
-tend to be incidental finding on endoscopy (tend to be benign)

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20
Q

What is another symptom of upper GI cancers?

A

jaundice

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21
Q

What are the red flags for jaundice?

A
  • Hepatomegaly presenting with irregular border on palpation
  • Unintentional weight loss
  • painless
  • ascites
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22
Q

What is ascites?

A

accumulation of fluid in the peritoneal cavity causing abdominal swelling

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23
Q

Why would you get ascites?

A

1) low albumin levels so more fluid leaks out
2) portal hypertension causing compression so water leaks out
3) depositions in the peritoneum due to damaged liver

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24
Q

What is hepatocellular carcinoma?

A
  • primary malignancy of the liver cells
  • very rare
  • links to underlying disease
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25
Q

Why is the liver a common site for metasteses?

A

-the portal system drains the entire GI tract so any malignant cells go through the liver and have the potential to come into contact with the liver cells

26
Q

What malignancies commonly metastasise to the liver?

A
  • lungs
  • breast
  • prostate
  • renal
  • skin
27
Q

What methods do metastasis spread to the liver?

A
  • haematogenous (portal spread)
  • lymphatics (common in carcinomas) (sentinel lymph node)
  • trancoelomic (ovarian)
28
Q

What is a sentinel lymph node?

A

the first lymph node a cancer is likely to drain to

29
Q

With abnormal LFT’s, what else should you be thinking?

A
  • pancreas

- bile duct

30
Q

How would patients with pancreatic cancer present?

A
  • if head of pancreas would get jaundice

- if body or tail would have more vague symptoms relating to function of pancreas e.g fatty stool

31
Q

What are the risk factors fo r pancreatic cancer?

A

-fam history
-smoking
-male
-age
chronic pancreatitis

32
Q

What is the prognosis for pancreatic cancer?

A

very poor

33
Q

What are the 3 key symptoms?

A

1) obstruction
2) PR bleed
3) change in bowel habit

need to look at symptoms together !!

34
Q

What are the symptoms of obstruction?

A

-abdomnial distension and abdominal pain (due to the distention)

35
Q

How do you know if the bowel is distended?

A 
measure diameter
NORMAL
SI - 3cm
LI - 6cm
caecum - 9cm
36
Q

What are the differential diagnosis for obstruction?

A

BENIGN

  • volvulus (bowel twist)
  • diverticular disease
  • hernias
  • strictures (inflammation and fibrous bands)
  • intussusception (1 portion of bowel slides onto other)
  • pyloric stenosis (babies get it - present with projectile vomiting)

MALIGNANT
-small vs large bowel
depends on where they get symptoms first e.g.
if in duodenum - vomiting as early sign
if in sigmoid colon, constipation is early sign

37
Q

What are the red flags for obstruction?

A
  • weight loss

- unexplained abdominal pain

38
Q

What are the diffferential diagnosis for PR bleeding?

A

BENIGN

  • haemorrhoids
  • anal fissures
  • infective gastrorenteritis
  • IBD
  • diverticular disease

MALIGNANT
-small vs large bowel cancer

39
Q

What questions would you ask someone who presents with PR bleeding?

A
  • fresh red blood (indicates LI)
  • malaena? - SI
  • associated sympotms
40
Q

What are the red flags for PR bleeding?

A
  • age dependent >50
  • iron deficiency anaemia
  • weight loss
  • change in bowel habit
  • tenesmus
41
Q

What is tenesmus?

A

recurrent inclination to evacuate bowels caused by disorder of the rectum and other illnesses

42
Q

What questions would you ask someone who presents with a change in bowel habits?

A
  • change in freqeuncy e.g. diarrhoea nad constipation
  • consistency
  • blwoating or abdominal discomfort
43
Q

What are the differential diagnosis for change in bowel habit?

A

BENIGN

  • thyroid disorder
  • IBD
  • medication related
  • IBS
  • Coeliac disease
44
Q

What are the red flag symptoms for change in bowel habit?

A
  • age dependent
  • iron deficiency anaemai
  • unexplained weight loss
  • PR bleeding
45
Q

What is the most common lower GI cancer?

A

large bowel cancer

-adenocarcinoma

46
Q

What are the risk factors for Large bowel cancer?

A
  • family history
  • IBD
  • FAP
  • diet high in processed foods and a sedentary lifestyle
47
Q

What screening is carried out for Large bowel cancer?

A

faecal occult blood sample

  • take sample of poo and look for blood
  • see if you need a colonoscopy
  • very successful screening
48
Q

What is FAP?

A

start with proliferation, get abnormal cell growth and dysplasia which changes the morphology and can progress to malignancy and invade the cell and mucosal layers beneath

49
Q

What are the 2 different types of large bowel cancer?

A

left sided colon cancer and right sided colon cancer

50
Q

What are the associated symptoms with RSCC? (caecum)

A
  • weight loss
  • anaemia
  • less likely to have bowel obstruction
  • mass in right iliac fossa
  • late change in bowel habits
  • more advanced disease at presntation
51
Q

What are the associated symptoms with LSCC? (ascending)

A
  • weight loss
  • PR bleeding
  • bowel obsturctions
  • tenesmus
  • mass in left iliac fossa
  • early change in bowel habit
  • less advanced disease at presentation
  • apple core sign on MRI/CT scan - stenosing the lumen
52
Q

What are the types of Small bowel cancer?

A

1) stromal
2) lymphoma
3) adenocarcinoma
4) sarcoma
5) carcinoid tumours (neuroendocrine tumours)

53
Q

What are the risk factors of small bowel cancer?

A

IBD
coeliac
FAP
diet

54
Q

What are the symptoms of small bowel cancer?

A

weight loss
abdominal pain!
blood in stools

55
Q

How can you manage GI malignancies?

A

TNM staging
blood test (FBD, tumour markers)
CT/MRI
colonoscopy

56
Q

What does T, N and M refer to?

A

T -the size of the primary tumour (T1-T4)
N - the extent of regional node metastasis via lymphatics (N0-N3)
M - the extent of distant metastatic spread via the blood (M0 or M1)

57
Q

What is the staging used specifically for GI malignancies?

A

Dukes staging

58
Q

What is Dukes A?

A

cancer confined to inner lining mucosa of bowel

59
Q

What is Duke’s B?

A

affects musculature surrounds the bowel

60
Q

What is Duke’s C?

A

also has lymph node invasion

61
Q

What is Duke’s D?

A

has metastases too

62
Q

What is the treatment for GI cancers?

A

chemotherapy
radiotherapy
surgical resections

GI (10 decks)

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