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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
Why is the liver a common site for metasteses?
-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
What malignancies commonly metastasise to the liver?
- lungs - breast - prostate - renal - skin
27
What methods do metastasis spread to the liver?
- haematogenous (portal spread) - lymphatics (common in carcinomas) (sentinel lymph node) - trancoelomic (ovarian)
28
What is a sentinel lymph node?
the first lymph node a cancer is likely to drain to
29
With abnormal LFT's, what else should you be thinking?
- pancreas | - bile duct
30
How would patients with pancreatic cancer present?
- 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
What are the risk factors fo r pancreatic cancer?
-fam history -smoking -male -age chronic pancreatitis
32
What is the prognosis for pancreatic cancer?
very poor
33
What are the 3 key symptoms?
1) obstruction 2) PR bleed 3) change in bowel habit need to look at symptoms together !!
34
What are the symptoms of obstruction?
-abdomnial distension and abdominal pain (due to the distention)
35
How do you know if the bowel is distended?
``` measure diameter NORMAL SI - 3cm LI - 6cm caecum - 9cm ```
36
What are the differential diagnosis for obstruction?
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
What are the red flags for obstruction?
- weight loss | - unexplained abdominal pain
38
What are the diffferential diagnosis for PR bleeding?
BENIGN - haemorrhoids - anal fissures - infective gastrorenteritis - IBD - diverticular disease MALIGNANT -small vs large bowel cancer
39
What questions would you ask someone who presents with PR bleeding?
- fresh red blood (indicates LI) - malaena? - SI - associated sympotms
40
What are the red flags for PR bleeding?
- age dependent >50 - iron deficiency anaemia - weight loss - change in bowel habit - tenesmus
41
What is tenesmus?
recurrent inclination to evacuate bowels caused by disorder of the rectum and other illnesses
42
What questions would you ask someone who presents with a change in bowel habits?
- change in freqeuncy e.g. diarrhoea nad constipation - consistency - blwoating or abdominal discomfort
43
What are the differential diagnosis for change in bowel habit?
BENIGN - thyroid disorder - IBD - medication related - IBS - Coeliac disease
44
What are the red flag symptoms for change in bowel habit?
- age dependent - iron deficiency anaemai - unexplained weight loss - PR bleeding
45
What is the most common lower GI cancer?
large bowel cancer | -adenocarcinoma
46
What are the risk factors for Large bowel cancer?
- family history - IBD - FAP - diet high in processed foods and a sedentary lifestyle
47
What screening is carried out for Large bowel cancer?
faecal occult blood sample - take sample of poo and look for blood - see if you need a colonoscopy - very successful screening
48
What is FAP?
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
What are the 2 different types of large bowel cancer?
left sided colon cancer and right sided colon cancer
50
What are the associated symptoms with RSCC? (caecum)
- 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
What are the associated symptoms with LSCC? (ascending)
- 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
What are the types of Small bowel cancer?
1) stromal 2) lymphoma 3) adenocarcinoma 4) sarcoma 5) carcinoid tumours (neuroendocrine tumours)
53
What are the risk factors of small bowel cancer?
IBD coeliac FAP diet
54
What are the symptoms of small bowel cancer?
weight loss abdominal pain! blood in stools
55
How can you manage GI malignancies?
TNM staging blood test (FBD, tumour markers) CT/MRI colonoscopy
56
What does T, N and M refer to?
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
What is the staging used specifically for GI malignancies?
Dukes staging
58
What is Dukes A?
cancer confined to inner lining mucosa of bowel
59
What is Duke's B?
affects musculature surrounds the bowel
60
What is Duke's C?
also has lymph node invasion
61
What is Duke's D?
has metastases too
62
What is the treatment for GI cancers?
chemotherapy radiotherapy surgical resections

GI (10 decks)

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