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
Ss
What are the differential diagnoses for obstruction
Benign:
◦ Volvulus
◦ Diverticular Disease
◦ Hernias
What are red flags of obstructing
◦ Unintentional weight loss
◦ Unexplained abdominal pain
Describe teh nature of pr bleeding
Fresh, bright red? - lower down
Malaena? - upper
Associated symptoms?
What can cause pr bleeding
Benign o Haemorrhoids o Anal fissures o Infective gastroenteritis o Inflammatory bowel disease o Diverticular disease Malignant o Small vs large bowel cancer
What are the red flags for pr bleeding
Age dependent
Iron deficient anaemia Unexplained weight loss Change in bowel habit
Tenesmus - Cancers that are in the rectum. When th recum stretches it sends of signals to defecate. Teesmeus is this sensation, but dont pass much. But sensation of incomplete emptying bc tumour is causing the stretch
Describe changes in bowel habit which may be reported
Change in frequency
◦ Diarrhoea?
◦ Constipation?
Change in consistency
◦ More watery?
Associated symptoms?
◦ Bloating
◦ Abdominal discomfort
What can cause change in bowel habit
Can depend what the change is eg if diarrhoea or constipation
Benign o Thyroid disorder o Inflammatory bowel disease o Medication related o Irritable bowel syndrome o Coeliac disease
What are the red flags for changes in bowel habit
Age dependent
Iron deficient anaemia Unexplained weight loss PR blood loss
What are the risk factors for large bowel cancer
Adenocarcinoma Third commonest cancer in the UK Risk factors include
o Family history
o Inflammatory bowel disease
o Polyposis syndromes e.g. FAP, HNPCC - Altered tumour suppressor gene - uncontrolled proliferation or growth
o Diet and lifestyle - Diets high in fat, sedentary lifestyle
SCREENING REALLY IMPOIRTANT - faecal occult blood samples - look for trace of blood in faecal sample
How can polyps progress to adenocarcinoma
S
Compare left sided to righ sided colon cancer
More distensible part of the colon so doesnt tend to become obstructed , facial matter is softer, oppostre on the left. So more likely to bleed on eft side RIGHT SIDED COLON CANCER Weight loss Anaemia ◦ Occult bleeding Less likely to have bowel obstruction Mass in right iliac fossa Late change in bowel habit More advanced disease at presentation
What are the types, risk factors and symptoms of small bowell cancer
RARE!! Five different types o Stromal o Lymphoma o Adenocarcinoma o Sarcoma o Carcinoid tumours Risk factors: IBD, coeliac disease, FAP, diet Symptoms include: weight loss, abdominal pain, blood in stools
What is the staging/dukes staging
Ss
Describe cancer management
TNM staging Blood test- FBC, tumour markers (e.g. CEA (raised in colorectal), CA 19-9 (increased in pancreatic)) CT/MRI Endoscopy/Colonoscopy Capsule endoscopy Treatment o Chemotherapy o Radiotherapy o Surgical resections
