Gi Malignancy Flashcards
How can dysphagia occur
Extraluminal Luminal Intraluminal Benign Malignant: ◦ Squamous cell carcinoma ◦ Adenocarcinoma Sources of compression make swallows harder - bloakcage, obstruction eats
What are the dysphagia red flags
Anaemia Loss of weight (unintentional) Anorexia Recent onset of progressive symptoms Masses/Malaena
What is oesophageal carcinoma
General point:
◦ Type of carcinoma is linked to the epithelial type
◦ i.e. Stratified squamous epithelium in the oesophagus -> squamous cell carcinomas
◦ Everywhere else in GI tract columnar epithelium -> adenocarcinomas
Therefore most malignancies in the oesophagus are squamous cell carcinoma
Lower third can develop adenocarcinoma
◦ Barrett
Describe teh presentation and risk factors of oesophageal carcinoma
Typically present with progressive dysphagia
◦ Spread is common if presenting with symptoms
Risk factors: Smoking, Barrett
What are the ref flags fro epigastric pain
Associated with bleeding . Altered on the way down or come back up
Malaena
◦ Altered blood coming from the
upper GI tract Haematemesis
What are causesof epigastirc pain
Oesophageal varices, gastric ulcer, duodenal ulcers acute gastritis
Describe teh presentation and risk factors of gastric cancer andprognosis
Typically in the cardia or antrum
◦ Adenocarcinomas Present with similar pain to peptic ulcer
◦ 50% have a palpable mass! Risk factors
◦ Smoking, high salt diet, family history, H. Pylori
General note: Chronic inflammation puts you at higher risk of malignancy
Peptic ulcers look benign but can become malignant - take. A biopsy
Prognosis generally poor
◦ 10% 5 year survival
◦ 50% after
What are other cancers that can occur in the stomach
Gastric lymphoma
◦ MALT tissue
◦ Similar presentation to gastric carcinoma
◦ Most associated with H. pylori
◦ Prognosis much better than gastric cancer
Gastrointestinal stromal tumours (GISTs)
◦ Sarcomas (not epithelial)
◦ Tend to be an incidental finding on endoscopy
What are teh red flags for jaundice
Hepatomegaly ◦ Irregular border Unintentional weight loss Ascites - Liver malignancy - ascites - different natures o portal hypertension - exudate ascites in malignancy, transudate ascites in portal hypertension Painless
How can malignancy occur in the liver
Primary malignancy very rare
◦ Hepatocellular carcinoma
◦ Typically links to underlying disease
Viral hepatits - any chronic inflammation puts at high risk of malignancy.
Think about the portal system
◦ Drains the entirety of the GI tract
◦ Any malignant cells go through the liver
◦ Therefore it is a common site for metastases
What malignancies commonly metastasise to the liver?
How do GI cancer spread
Haematogenous ◦ Portal spread
Lymphatics
◦ Common in carcinomas
◦ Sentinal lymph node
Describe hw pancreatic cancer can present
Presentation:
◦ Head: Jaundice - impinges on bile duct
◦ Body/tail: Symptoms more vague
◦ 80% ductal adenocarcinomas
Risk factors:
◦ Family history, smoking
◦ Men affected more than women, incidence increases with age (typically >60yrs)
◦ Chronic pancreatitis
Prognosis very poor
What are 3 key symptoms of lower gi malignancy
Three key symptoms: 1. Obstruction 2. Per Rectum (PR) bleeding 3. Change in bowel habit Often need to look at these symptoms together
What are the general symptons of obstruction
General Symptoms:
◦ Abdominal distension - accumulation of air ad nothing can pass though
◦ Abdominal pain - Methodical contractions against the blockage causes pain
Compare small vs large bowel obstruction
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