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GI tract > GI malignancy > Flashcards

GI malignancy Flashcards

1
Q

What are common sites of cancer in the GI system?

A
  • Oesophagus
  • Liver
  • Stomach
  • Pancreas
  • Gallbladder
  • Large intestine
  • Anus
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2
Q

What is the difference between carcinoma and adenocarcinoma?

A
  • Carcinoma is malignancy of cells that make up epithelial lining of skin or tissue lining organs
  • Adenocarcinoma is malignancy of glandular cells in epithelial tissue
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3
Q

What is an adenoma?

A
  • Benign tumour formed from glandular structures in epithelial tissues
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4
Q

What presentation is suggestive of oesophageal cancer?

A
  • Severe dysphagia to solids
  • Worsening dysphagia to liquids
  • Unexplained weight loss
  • Mild odynophagia
  • Coughing up mucus secretions
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5
Q

What is the histology of oesophageal cancer?

A
  • Most common squamous cell carcinoma worldwide
  • Generally affects upper 2/3
  • Adenocarcinomas from columnar epithelium can occur in lower 1/3
  • Barrett’s oesophagus
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6
Q

What are the red flags for oesophageal cancer?

A
  • Progressive dysphagia
  • Anaemia
  • Unintentional weight loss
  • Anorexia
  • Recent onset of progressive symptoms
  • Malaena or masses
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7
Q

What are the risk factors for oesophageal cancer?

A
  1. Squamous cell carcinoma
    - smoking
    - alcohol use
    - dietary intake e.g. hot beverages
  2. Adenocarcinomas
    - obesity
    - reflux disease
    - Barrett’s oesophagus
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8
Q

What is the prognosis of oesophageal cancer?

A
  • 5% survival at 5 years
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9
Q

What are the investigations for oesophageal cancer?

A
  • FBC to check for anaemia
  • Oesophagogastroduodenoscopy (OGD) with biopsy - helps to determine whether benign or cancerous
  • CT thorax and abdomen - size of primary, local invasion, metastatic spread
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10
Q

What is the treatment for oesophageal cancer?

A
  • Endoscopic therapies (limited disease)
  • Oesphagectomy (removes oesophagus)
  • Chemoradiotherapy
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11
Q

What is the histology of gastric cancer?

A
  • Most commonly adenocarcinomas
  • Most often found in gastric cardia
  • Can get lymphoma, leiomyosarcoma, neuroendocrine tumours
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12
Q

How is gastric cancer classified?

A
  • Location - either cardia gastric cancer or non-cardia gastric cancer
  • Lauren classification tells us the type
  • Either diffuse or intestinal
  • Diffuse occurs more often in young people and has worse prognosis
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13
Q

What are the general risk factors for gastric cancer?

A
  • Age 50-70
  • Male
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14
Q

What are the strong risk factors for gastric cancer?

A
  • Pernicious anaemia
  • H-Pylori
  • N-nitroso compounds
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15
Q

What are the weak risk factors for gastric cancer?

A
  • Family history
  • High salt (weakens gastric mucosa and enhances negative effects of N-nitroso compounds)
  • Smoking
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16
Q

What is the common clinical presentation of gastric cancer?

A
  • Unexplained weight loss
  • Epigastric abdominal pain
  • Lymphadenopathy - Virchow’s node (left supraclavicular fossa)
  • Dysphagia (if cancer is located around the cardia)
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17
Q

What is the prognosis of gastric cancer?

A
  • 70% 5-year survival for local disease
  • Decreases to 5% if there’s metastasis
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18
Q

What are the investigations for gastric cancer?

A
  • Bloods - look for iron deficiency anaemia
  • Upper GI endoscopy and biopsy for tissue diagnosis
  • CT CAP (chest, abdomen and pelvis) for staging/determining extent of disease
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19
Q

How is gastric cancer managed?

A
  • Endoscopic mucosal resection - treats superficial cancer
    -Surgery to remove all or part of the stomach (gastrectomy) - treats localised cancer
  • If pt not suitable for surgery, then chemoradiation
  • Chemotherapy/immunotherapy and supportive care - treats advanced/metastatic cancer
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20
Q

What is the histology of pancreatic cancer?

A
  • Pancreatic ductal adenocarcinoma is main type
  • Pancreatic neuroendocrine tumours are rare and originate from pancreatic endocrine cells
  • Cancers may be non-functional or may secrete hormones
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21
Q

What are the risk factors for pancreatic cancer?

A
  • Smoking
  • Chronic pancreatitis
  • Inherited mutations
  • Men > women
  • Increasing age
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22
Q

Which mutations can lead to pancreatic cancer?

A
  • BRCA1
  • BRCA2
  • PALB2
  • Familial syndromes
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23
Q

What is the clinical presentation of pancreatic cancer?

A
  • Painless jaundice
  • Unexplained weight loss
  • Abdominal/back pain
  • New-onset type 2 diabetes mellitus in an adult over 50 without any obesity-related risk factors
24
Q

What are the symptoms of pancreatic cancer?

A
  • Indigestion
  • Tummy pain or back pain
  • Changes to your poo
  • Unexplained weight loss/loss of appetite
  • Jaundice
25
Q

What are the investigations for pancreatic cancer?

A
  • Bloods - LFTs if jaundiced, CA 19-9 (tumour marker)
  • CT - focused on pancreas can give very high diagnostic accuracy and can assess resectability in 80-90%
  • Ultrasound scan - can detect cancer arising in head of pancreas with reasonable accuracy but not in body or tail
26
Q

What is the management for pancreatic cancer?

A
  • 10-15% are suitable for surgical resections (followed by pancreatic enzyme replacement)
  • Only possible cure
  • 20% 5 year survival
  • Biliary stenting to relieve jaundice
  • Chemotherapy and symptom management (if not resectable)
27
Q

What is the histology of hepatocellular carcinoma?

A
  • Hepatocellular carcinoma
  • Primary cancer arising from hepatocytes (usually with a background of cirrhosis)
28
Q

What are the risk factors for hepatocellular carcinoma?

A
  • Occur in patients with underlying cirrhosis
  • Many causes of cirrhosis including alcohol, Hep B&C
29
Q

What is the clinical presentation of hepatocellular carcinoma?

A
  • Symptoms of underlying liver disease can often mask malignancy e.g. ascites, fatigue
  • Acute hepatic decompensation or RUQ pain can be signs of development of HCC
30
Q

What is the prognosis of hepatocellular carcinoma?

A
  • 5 year survival rate ~50% with complete surgical resection or liver transplantation
  • In advanced HCC = median overall survival time with treatment is approx 1 year
31
Q

What are the investigations for hepatocellular carcinoma?

A
  • Blood tests for LFTs, prothrombin time/INR (checks synthetic function), viral hepatitis panel
  • USS - non invasive and good for screening high risk pts
  • CT/MRI of abdomen
  • Liver biopsy
32
Q

What is the treatment for hepatocellular carcinoma?

A
  • If suitable then ablation, resection or transplantation
  • If not suitable for any of the above then chemotherapy/immunotherapy to slow tumour growth
33
Q

Outline liver metastases

A
  • Liver is a common site for metastases from many cancer types
  • Can be haematological e.g. portal spread from other GI viscera
  • Or lymphatic spread
  • Or spread via other routes e.g. ovarian is via transcoelomic spread
34
Q

What is the histology for cholangiocarcinoma (bile duct cancers)?

A
  • Majority are adenocarcinomas
  • Can be intra- or extrahepatic
35
Q

What are the risk factors for cholangiocarcinoma?

A
  • Liver and bile duct diseases - cirrhosis, alcoholic liver disease, non-specific bile duct diseases, gallstones, primary sclerosing cholangitis
  • Infections
  • High alcohol consumption
  • Exposure to certain toxins/medications
36
Q

What is the clinical presentation of cholangiocarcinoma?

A
  • Painless jaundice
  • Pruritis
  • Dark urine
  • Light colour stool (absence of stercobilin due to biliary obstruction)
37
Q

What is the prognosis of cholangiocarcinoma?

A
  • Generally poor
  • 5 year overall survival rate in patients with metastatic disease is 2%
38
Q

What is the histology of colorectal cancer?

A
  • Adenocarcinomas which progress from normal epithelium in a classical pattern
39
Q

What are the risk factors of colorectal cancer?

A
  • High dietary fat
  • High red meat consumption
  • Low dietary fibre
  • Alcohol intake
  • History of IBD
  • Genetic conditions such as FAP and HNPCC
40
Q

What is the clinical presentation of colorectal cancer?

A
  • Blood in stool
  • Altered bowel habits
  • Bowel obstruction
  • Perforation
  • Symptoms due to hepatic or peritoneal metastases e.g. abdo pain or ascites
41
Q

What is the prognosis of colorectal cancer?

A
  • Best overall prognosis
  • 5-year survival rate ranges from 50% - 95% (non-metastatic)
42
Q

What are the red flags of colorectal cancer?

A
  • Blood in the stool/rectal bleeding (either fresh red vs mixed in stool vs malaena)
  • Change in bowel habit
  • Iron deficiency anaemia
  • Unexplained weight loss
  • Tenesmus
  • Mass on rectal examination
43
Q

How may bowel habits change due to colorectal cancer?

A
  • Inquire more about pain when opening bowels (makes it more likely to be haemorrhoids or fissures)
  • If black and tarry stool - more likely to be upper GI
  • As we get older, a change in bowel habit is more likely to be due to malignancy
  • Can present with constipation as cancer can obstruct bowels
  • Can lead to overflow diarrhoea
44
Q

Outline the features of right-sided colorectal cancer

A
  • Weight loss
  • Occult bleeding (not visible to naked eye)
  • Less likely to present with bowel obstruction
  • Mass in right iliac fossa
    -More advanced disease at presentation
  • Late change in bowel habits
  • Fungating (ulceration)
45
Q

Outline the features of left-sided colorectal cancer

A
  • Weight loss
  • Rectal bleeding (bright red and fresh)
  • Bowel obstruction more likely
  • Mass in left iliac fossa
  • Less advanced disease at presentation
  • Early change in bowel habit
  • Stenosing (strictures/narrowing)
46
Q

What is the adenocarcinoma sequence?

A
  • Series of genetic and epi-genetic mutations
  • Activation of oncogenes
  • Inactivation of tumour suppressor genes
  • Normal glandular epithelial cells become adenomas
  • Adenomas become invasive carcinomas
47
Q

What are the investigations for colorectal cancer?

A
  • Stool tests e.g. FIT
  • Blood tests - FBC for anaemia, CEA
  • Colonoscopy and biopsy
  • Imaging - CT and MRI
48
Q

How is colorectal cancer managed?

A
  • Largely dependent on stage
  • Surgery with pre or post-operative chemotherapy/ immunotherapy
  • Chemotherapy/immunotherapy if not for surgical intervention
49
Q

What are the barriers to participating in bowel screening?

A
  • Fear and denial around test outcome
  • Individual perceived low risk/doesn’t want to know result
  • Being male
  • Pt believes that test is not applicable to them
  • Ethnic minorities
  • ## Lower socio-economic group
50
Q

What are the barriers to participating in bowel screening?

A
  • Fear and denial around test outcome
  • Being male
  • Pt believes that test is not applicable to them
  • Ethnic minorities
  • Lower socio-economic group
51
Q

What is the histology of anal cancer?

A
  • Squamous cell carcinomas
52
Q

What are the risk factors for anal cancer?

A
  • Strongly associated with HPV infection
  • HIV infection
  • Engaging in anal-receptive sexual intercourse
  • Chronic local inflammation due to IBD and recurrent anal fissures
53
Q

What is the clinical presentation of anal cancer?

A
  • Perianal pruritis or pain
  • Bleeding
  • Discharge
  • Mass-like sensation
54
Q

What is the prognosis of anal cancer?

A
  • More than 70% of cases can be cured with chemoradiation
55
Q

How do we lower the incidence of anal cancer?

A
  • Pap smears in high-risk populations
  • Treatment of HIV infection
56
Q

How is GI cancer staged (TNM staging)?

A
  • TNM staging is standardised system
  • T = size of primary tumour
  • N = extent of regional lymph node involvement
  • M = metastatic spread
  • Typically then converted to an overall stage 1, 2, 3 or 4
57
Q
A

GI tract (23 decks)

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