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Cancer Care Block > GI Malignancy > Flashcards

GI Malignancy Flashcards

1
Q

Name all dem symptoms you should ask about/look for if GI malignancy might be suspected.

A 
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
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2
Q

Who is affected by colorectal cancer? Give me demographics.

A 
M>F
Increasing incidence with decreasing mortality
4th most common solid cancer
Average age is over 75
More common in the western world
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3
Q

What are the risk factors for colorectal cancer?

A 
Being male
Red meat, low fibre, and processed meat in diet
Family history
Overweight
Smoking
Alcohol

Exercise is protective

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4
Q

How is colorectal cancer staged?

A

TNM

Dukes is being phased out

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5
Q

What is the criteria for a 2 week wait referral for suspected oesophageal or gastric cancer?

A

Dysphagia at any age OR above 55 with weight loss
AND
Upper abdo pain OR reflux OR dyspepsia

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6
Q

What are the red flags for referring for upper GI endoscopy?

A 
ALARMS:
Anaemia
Loss of weight
Anorexia
Recent onset/progression
Melaena/haematemesis
Swallowing difficulties
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7
Q

Why is endoscopy the gold standard for investigation and diagnosis of GI cancer?

A

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

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8
Q

If a biopsy comes back as malignant in GI cancer, what is the next investigative step?

A

CTCAP to work out disease extent and help staging

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9
Q

Where does stomach cancer often metastasise to?

A

Lungs
Liver
Oesophagus

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10
Q

How are gastric cancers staged?

A

TNM

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11
Q

How do we find out the stage for gastric cancers?

A

Endoscopy and biopsy
USS
CTCAP

PET can be used, but more for mets

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12
Q

How is stage 1 gastric cancer treated?

A

Surgery +- chemotherapy

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13
Q

What surgery can we use for gastric cancer?

A

Sub total or total gastrectomy
Resection
Lymph node clearance

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14
Q

What chemo is often used for gastric cancer?

A

5-FU
or
Cisplatin combination (ECX, EOX, ECF)

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15
Q

What can we do palliatively for gastric cancer?

A 
Symptom control
Chemo
Surgery
Stenting
Blood transfusions
Steroids to boost appetite

MDT approach

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16
Q

What are the 8 Cs of haematemesis management?

A 
Cannula (1 or 2 large bore)
Crossmatch
Crystalloids
Catheter
Clotting
Cold-prick drugs (warfarin, other blood thinners)
Camera (OGD)
Call surgeons & for help
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17
Q

What is GIST?

A

Gastrointestinal stromal tumour - rare soft tissue sarcoma

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18
Q

What is difficult about diagnosing a GIST?

A

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.

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19
Q

What kinds of nutritional support are available for pts with GI cancers?

A

Use of soft foods, fluids, and nutritional supplements e.g. fortisip
Parenteral nutrition
Enteral nutrition

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20
Q

What are the advantages for enteral nutrition?

A 
Keeps gut working
Measurable
Adaptable for pt needs
Decreases risk of aspiration
Can administer medication via tubes
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21
Q

What are the disadvantages of total parenteral nutrition?

A 
Infection due to chroic IV access
Blood clots
Physical hunger
Gut atrophy
Refeeding syndrome
Volume overload
22
Q

What is the radioactive tracer used in PET scans called?

A

fluorodeoxyglucose

23
Q

How is localised oesophageal cancer managed?

A

Oesophagectomy +- neoadjuvant/adjuvant chemo/radiotherapy

24
Q

What is the prognosis for oesophageal cancer?

A

Poor - 10% 5 yr survival

25
Q

If a tumour of the rectum involves the anus, what is the best surgical option?

A

Abdominoperineal resection

26
Q

What does a transverse colectomy remove?

A

The transverse colon

27
Q

What does a left hemicolectomy remove?

A

Removes the entire left hemicolon

28
Q

What is an anterior resection?

A

Removal of the rectum.

May be high or low, but leaves the anus.

29
Q

What is Hartmann’s procedure?

A

Sigmoid colon and upper rectum are removed, and an end colostomy is formed.

30
Q

What cell type is associated with gastric adenocarcinoma on biopsy?

A

Signet ring cells

31
Q

What is the most common extra-colonic malignancy associated with HNPCC?

A

Endometrial cancer

32
Q

What is the 5 year survival rate associated with colorectal cancer?

A

Around 45-50%

33
Q

Do survival rates change much after 5 years for colorectal cancer?

A

No, only very slight decline, as most pts who live this long are cured.

34
Q

What is the 5 year survival rate associated with oesophageal cancer?

A

20-25% overall.

This is differetn according to the pts pre-op status, comorbidities, and presence/absence of mets.

35
Q

What is the 5 year survival rate associated with gastirc cancer?

A

11%, but differs depending on pt age.

Under 50 - 16-22% 5 years survival.
Over 70 - 5-12% 5 years survival.

36
Q

What long term complications/sequelae might a pt with GI cancer experience?

A
  • 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.
37
Q

What are the T stages for gastric cancer?

A 
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
38
Q

What things might we need to take into account when palliating someone who has had GI cancer?

A
  • Swallowing/dysphagia
  • Nutrition/malabsorption
  • Pain relief
  • Mouth care
  • Constipation
  • Bowel obstruction
  • Haemorrhage
  • Liver/lung mets
  • Appetite/anorexia
39
Q

How can we assist pts palliatively with swallowing dificulties?

A

Stenting
Reduction of size/bulk of tumour locally
Nutritional assistance

40
Q

How can we assist with nutrition for pts with GI cancer?

A

Liquid feeds to help with swallowing
Enteral nurition
PEG tube

41
Q

How can we assist pts palliatively with pain?

A

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.

42
Q

How can we potentially help with reduced appetite and anorexia in GI palliative care?

A

Assist with nutrition

Corticosteroids to stimulate appetite and weight gain

43
Q

How does management of bowel obstruction differ in a cancer pt compared to another pt?

A
  • Have to take disease extent into account
  • In more advanced disease, symptom control and comfort are the ultimate goals
  • 1/3 resolve spontaneously
44
Q

What can we give palliatively to a pt with bowel obstruction?

A
  • Glucocorticoids
  • Antiemetics
  • Laxatives
  • Opioids
  • Antisecretories e.g. Buscopan
45
Q

What is malignant gastric outlet obstruction?

A

Clinical syndrome that occurs as a consequence of a cancer causing mechanical impediment to gastric emptying.

46
Q

Which cancers are usually the cause of gastric outlet obstruction?

A

Primary pancreatic, gastric, and duodenal carcinoma.

47
Q

What are presenting symptoms of gastric outlet obstruction?

A 
Nausea
Vomiting
Abdominal distention
Pain
Decreased oral intake
48
Q

What are the complications of gastric outlet obstruction?

A

Dehydration
Malnutrition
Poor QoL

49
Q

What is the primary therapeutic modality to manage gastric outlet obstruction?

A

Endoscopic stent placement

50
Q

What are the options for recurrence of gastric outlet obstruction following a stent placement?

A
  • Redo the stent - good outcomes

- Surgical bypass

51
Q

Why is dysphagia associated with GI cancer?

A

Caused by presence of tumour causing obstruction or mechanical difficulty, and chemo/radiotherapy and surgery can cause dysphagia.

52
Q

What side effects of cancer treatment can cause dysphagia?

A
  • Fibrosis/scarring
  • Infections
  • Swelling/narrowing
  • Physical changes to mouth/oesophagus
  • Mucositis -> pain/inflammation
  • Xerostomia

Cancer Care Block (10 decks)

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