GI Malignancy Flashcards
Name all dem symptoms you should ask about/look for if GI malignancy might be suspected.
Constitutional - weight loss, night sweats, pain, cachexia, fever, malaise Symptoms of anaemia Dysphagia/dyspepsia Haematemesis Obstruction Change in bowel habit (frequency, consistency) Melaena PR bleeding PR mucus Felling of incomplete voiding/tenesmus Jaundice
Who is affected by colorectal cancer? Give me demographics.
M>F Increasing incidence with decreasing mortality 4th most common solid cancer Average age is over 75 More common in the western world
What are the risk factors for colorectal cancer?
Being male Red meat, low fibre, and processed meat in diet Family history Overweight Smoking Alcohol
Exercise is protective
How is colorectal cancer staged?
TNM
Dukes is being phased out
What is the criteria for a 2 week wait referral for suspected oesophageal or gastric cancer?
Dysphagia at any age OR above 55 with weight loss
AND
Upper abdo pain OR reflux OR dyspepsia
What are the red flags for referring for upper GI endoscopy?
ALARMS: Anaemia Loss of weight Anorexia Recent onset/progression Melaena/haematemesis Swallowing difficulties
Why is endoscopy the gold standard for investigation and diagnosis of GI cancer?
It is less invasive/traumatic than surgery
A biopsy can be collected for histology
The lesion can be visualised
Lesions can be removed (e.g. polyps) or treatment can be administered
If a biopsy comes back as malignant in GI cancer, what is the next investigative step?
CTCAP to work out disease extent and help staging
Where does stomach cancer often metastasise to?
Lungs
Liver
Oesophagus
How are gastric cancers staged?
TNM
How do we find out the stage for gastric cancers?
Endoscopy and biopsy
USS
CTCAP
PET can be used, but more for mets
How is stage 1 gastric cancer treated?
Surgery +- chemotherapy
What surgery can we use for gastric cancer?
Sub total or total gastrectomy
Resection
Lymph node clearance
What chemo is often used for gastric cancer?
5-FU
or
Cisplatin combination (ECX, EOX, ECF)
What can we do palliatively for gastric cancer?
Symptom control Chemo Surgery Stenting Blood transfusions Steroids to boost appetite
MDT approach
What are the 8 Cs of haematemesis management?
Cannula (1 or 2 large bore) Crossmatch Crystalloids Catheter Clotting Cold-prick drugs (warfarin, other blood thinners) Camera (OGD) Call surgeons & for help
What is GIST?
Gastrointestinal stromal tumour - rare soft tissue sarcoma
What is difficult about diagnosing a GIST?
Has to be confirmed with biopsy but the risks of biopsy includes very real chance that cancer will spread. Have to completely remove it or do nothing.
What kinds of nutritional support are available for pts with GI cancers?
Use of soft foods, fluids, and nutritional supplements e.g. fortisip
Parenteral nutrition
Enteral nutrition
What are the advantages for enteral nutrition?
Keeps gut working Measurable Adaptable for pt needs Decreases risk of aspiration Can administer medication via tubes
What are the disadvantages of total parenteral nutrition?
Infection due to chroic IV access Blood clots Physical hunger Gut atrophy Refeeding syndrome Volume overload
What is the radioactive tracer used in PET scans called?
fluorodeoxyglucose
How is localised oesophageal cancer managed?
Oesophagectomy +- neoadjuvant/adjuvant chemo/radiotherapy
What is the prognosis for oesophageal cancer?
Poor - 10% 5 yr survival
If a tumour of the rectum involves the anus, what is the best surgical option?
Abdominoperineal resection
What does a transverse colectomy remove?
The transverse colon
What does a left hemicolectomy remove?
Removes the entire left hemicolon
What is an anterior resection?
Removal of the rectum.
May be high or low, but leaves the anus.
What is Hartmann’s procedure?
Sigmoid colon and upper rectum are removed, and an end colostomy is formed.
What cell type is associated with gastric adenocarcinoma on biopsy?
Signet ring cells
What is the most common extra-colonic malignancy associated with HNPCC?
Endometrial cancer
What is the 5 year survival rate associated with colorectal cancer?
Around 45-50%
Do survival rates change much after 5 years for colorectal cancer?
No, only very slight decline, as most pts who live this long are cured.
What is the 5 year survival rate associated with oesophageal cancer?
20-25% overall.
This is differetn according to the pts pre-op status, comorbidities, and presence/absence of mets.
What is the 5 year survival rate associated with gastirc cancer?
11%, but differs depending on pt age.
Under 50 - 16-22% 5 years survival.
Over 70 - 5-12% 5 years survival.
What long term complications/sequelae might a pt with GI cancer experience?
- Stoma
- Malabsorption
- Risk of obstruction/adhesions
- Nausae/vomiting
- Psychological - anxiety, depression, sleep disturbance, sexual dysfunction.
- Urinary problems e.g. incontinence
- Altered bowel habit
- Hernia through operation site
- Nerve damage from chemo or other ADRs.
What are the T stages for gastric cancer?
T0 - no primary tumour Tis - carcinoma in situ T1 - invades lamina propria or submucosa T2 - invades muscularis propria/subserosa T3 - invades visceral peritoneum T4 - invades adjacent structures
What things might we need to take into account when palliating someone who has had GI cancer?
- Swallowing/dysphagia
- Nutrition/malabsorption
- Pain relief
- Mouth care
- Constipation
- Bowel obstruction
- Haemorrhage
- Liver/lung mets
- Appetite/anorexia
How can we assist pts palliatively with swallowing dificulties?
Stenting
Reduction of size/bulk of tumour locally
Nutritional assistance
How can we assist with nutrition for pts with GI cancer?
Liquid feeds to help with swallowing
Enteral nurition
PEG tube
How can we assist pts palliatively with pain?
Like with any other pt - WHO pain ladder, ensuring to safetynet for constipation appropriately.
Coeliac plexus nerve block can be good for Rx-resistant pain in gastric carcinoma.
How can we potentially help with reduced appetite and anorexia in GI palliative care?
Assist with nutrition
Corticosteroids to stimulate appetite and weight gain
How does management of bowel obstruction differ in a cancer pt compared to another pt?
- Have to take disease extent into account
- In more advanced disease, symptom control and comfort are the ultimate goals
- 1/3 resolve spontaneously
What can we give palliatively to a pt with bowel obstruction?
- Glucocorticoids
- Antiemetics
- Laxatives
- Opioids
- Antisecretories e.g. Buscopan
What is malignant gastric outlet obstruction?
Clinical syndrome that occurs as a consequence of a cancer causing mechanical impediment to gastric emptying.
Which cancers are usually the cause of gastric outlet obstruction?
Primary pancreatic, gastric, and duodenal carcinoma.
What are presenting symptoms of gastric outlet obstruction?
Nausea Vomiting Abdominal distention Pain Decreased oral intake
What are the complications of gastric outlet obstruction?
Dehydration
Malnutrition
Poor QoL
What is the primary therapeutic modality to manage gastric outlet obstruction?
Endoscopic stent placement
What are the options for recurrence of gastric outlet obstruction following a stent placement?
- Redo the stent - good outcomes
- Surgical bypass
Why is dysphagia associated with GI cancer?
Caused by presence of tumour causing obstruction or mechanical difficulty, and chemo/radiotherapy and surgery can cause dysphagia.
What side effects of cancer treatment can cause dysphagia?
- Fibrosis/scarring
- Infections
- Swelling/narrowing
- Physical changes to mouth/oesophagus
- Mucositis -> pain/inflammation
- Xerostomia
