GI Malignancy Flashcards by Sophie Wakeling

How common are GI malignancies?

Very, Bowel cancer is 3rd most common to Male and female and 4th most common overall.

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What things can cause dysphagia?

Extralumnal
Luminal - foreign bodies
Intraluminal - growths, malignancies

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What are the red flags for dysphagia?

A -Anaemia
L -Loss of weight (unintentional)
A -Anorexia
R -Recent onset of progressive symptoms
M -Masses/Malena

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What type of cancer are most GI cancers?

Carcinoma’s -Mostly related to type of epithelia there are

Adenocarcinoma everywhere but oesophagus as columnar epithelium.

Squamous cell carcinoma in oesophagus as stratified squamous epithelia.

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What malignancies present in oesophagus?

Squamous cell carcinoma

Lower third - adenocarcinoma because of Barrett’s oesophagus

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What symptom do patients typically present with?

Progressive dysphagia - spread is common if presenting with symptoms

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What is the prognosis for oesophageal carcinoma?

Prognosis is poor - 5% survival at 5 years.

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What are the risk actors for oesophageal carcinomas?

Smoking

Barrett’s oesophagus

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What are the red flags for epigastric pain?

Melaena - Altered blood coming from the upper Gi tract

Haematemesis - causes by Oesophageal varices, Gastric ulcer, duodenal ulcer, acute gastritis, Mallory-Weiss syndrome

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Where do gastric cancers typically occur?

Cardia or antrum - typically adenocarcinoma.

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How do gastric cancer’s present?

Pain similar to peptic ulcer and 50% have a palpable mass.

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What are the risk factors for gastric cancers?

Smoking, high salt diet, family history, H. Pylori, chronic inflammation

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What is the prognosis for gastric cancer?

Prognosis is generally poor.
10% 5 year survival
50% after ‘curative’ surgery

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What other cancers 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

Gastrointestinl stromal tumours (GISTs)

Sarcoma’s (not epithelial)
Incidental finding on endoscopy
Mostly benign

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What are the red flags for jaundice?

Hepatomegaly with irregular borders
Unintentional weight loss
Ascites
Painless

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What cancers are commonly found in the liver?

Most commonly metastasises as Hepatocellular carcinoma is rare.

E.g liver, bowel, breast

This is because of the portal system so it drains the entirely of the GI tract so any malignancies go through the liver.

What is a sentinal lymph node?

First lymph nodes metastatic cells go to.

How do pancreatic cancers present?

Head: jaundice
Body / tail: Vague symptoms

80% are ductal adenocarcinomas.

What are the risk factors for pancreatic cancers?

Family history, smoking
Men
Age
Chronic pancreatitis

What is the prognosis for pancreatic cancer?

VERY poor.

Survival rate typically 8-12months and can be less.

What are the three key symptoms fo lower GI malignancies?

Obstruction - abdominal distention and pain

Per Rectum bleeding

Change in bowel habit

What are some differentials for obstruction?

Volvulus
Diverticular disease
Hernias

What are the red flags for obstruction?

Unintentional weight loss

Unexplained abdominal pain

What do you ask about PR bleeding?

Fresh, bright red?
Malaena?
Associated symptoms?

What could cause PR bleeding?

Benign: - Haemorrhoids - Anal fissures - Infective gastroenteritis - IBD - Diverticular disease Malignant Small vs large bowel cancer

What are the red flags for PR bleeding?

Age dependant (if 50+ more worrying) Iron deficiency anaemia Unexplained weight loss Change in bowel habit Tenesmus - feeling like you need to poo but not

What do you ask about change in bowel habits?

Change in frequency - Diarrhoea - Constipation Change in consistency -More watery? Associated symptoms - Bloating? - Abdominal discomfort?

What differential diagnosis could cause diarrhoea?

``` Thyroid IBD Medication IBS Coeliac ```

What are the red flags for change in bowel habits?

Age dependant Iron deficiency anaemia Unexplained weight loss PR blood loss

What are the risk factors for large bowel cancers?

Family history Inflammatory bowel disease Polyposis syndromes Diet and lifestyles

Describe the adenomacarcinoma sequence

Hyperproliferation - adenomatous polyps (small then large) Severe dysphasia (precancerous polyp) Adenocarcinoma (now malignant) Invasive cancer

How do right sided colon cancers present?

``` Weight loss Anaemia - occult bleeding Less likely to have bowel obstruction Mass in RIF Late change in bowel habit More advanced at presentation 'Fungating' ```

How do left sided colon cancers present?

``` Weight loss Rectal bleeding Bowel obstruction Tenesmus Mass in LIF Early changes in bowel presentation ‘Stenosing’ ```

What are the 5 different types of small bowel cancer?

``` Stromal Lymphoma Adenocarcinoma Sarcoma Carcinoid tumours ```

What are the risk factors for small bowel cancers?

IBD, Coeliac disease, FAP, diet

What are the symptoms for small bowel cancers?

Weight loss, abdominal pain, blood in stools

Describe TNM staging

T - Tumour (0-3) N - Nodes (0-2) M -Metastases (0-X) Colorectal carcinoma - use Duke’s staging

How do you diagnose cancer?

``` TNM staging Blood tests - FBC, tumour markers CT/ MRI Endoscopy / colonoscopy Capsule endoscopy ```

How do you treat cancer?

Chemotherapy Radiotherapy Surgical resection