GI Malignancy Flashcards
What are three categories for dysphagia, give examples?
Extraluminal - from outside e.g. lung/ heart pathology
Luminal e.g. outgrowth of lumen wall
Intraluminal e.g. foreign bodies, strictures, benign lump or malignant (squamous cell carcinoma/ adenocarcinoma)
Red flags for dysphagia
ALARM
Anaemia (invading structures-> bleeding)
Loss of weight (unintentional)
Anorexia
Recent onset of progressive symptoms
Masses/ Malaena
What’s one sign dysphagia is neurological?
There will be difficulty swallowing liquids and solids simultaneously from the beginning
Oesophageal carcinoma type
Squamous cell carcinoma as stratified squamous epithelium in oesophagus (everywhere else bar distal anus in GI tract adenocarcinomas from simple columnar)
Lower third oesophagus can develop adenocarcinoma from Barrett’s metaplasia SS->SC
Oesophageal carcinoma presentation, risk factors, prognosis, diagnosis
Typically progressive dysphagia
Risk factors: smoking, Barrett’s
Prognosis: 5% survival at 5 yrs
Diagnosis: barium swallow and OGD endoscopy + biopsy
What are the 9 quadrants of the abdomen for pain presentation, give some causes for each quadrant pain?
From right top across then right middle across then right bottom across:
- hypochondriac right (gallstones, cholangitis, hepatitis, liver abscess, cardiac causes, lung causes)
- epigastric (oesophagitis, peptic ulcer, acute gastritis, oesophageal varices, perforated ulcer, pancreatitis, gastric cancer)
- hypochondriac left (spleen abscess, acute splenomegaly, spleen rupture)
—— transpyloric plane ———-
- right lumbar (ureteric colic, pyelonephritis)
- umbilical (early appendicitis, mesenteric adenitis, meckel’s diverticulitis, lymphomas)
- left lumbar (ureteric colic, pyelonephritis)
——- transtubercular plane ———
- Right iliac - appendicitis, Crohn’s, caecum obstruction, ovarian cyst, ectopic pregnancy, hernias
- Hypogastric (testicular torsion, urinary retention, cystitis, placental abruption)
- left iliac (diverticulitis, ulcerative colitis, constipation, ovarian cyst, hernias)
Epigastric pain red flags
Malaena (black tar stool - altered blood coming from upper Gi tract)
- haematemesis
Gastric cancer - location, type, presentation, risk factors, prognosis
Typically in cardia/ antrum
Adenocarcinomas
Similar pain to peptic ulcers (epigastric), cancer symptoms, 50% have palpable mass
Risk factors: smoking, high salt, family history, H.Pylori, Chronic inflammation puts you at higher risk of malignancy
Prognosis- 10% 5yr survival, 50% after curative surgery
Screening not in UK as low prevalence
Other cancers of the stomach bar gastric carcinoma
Gastric lymphoma - MALT tissue, similar presentation to gastric carcinoma - most associated H.pylori, prognosis much better
Gastrointestinal stromatolites tumours - sarcomas (soft tissue), tend to be incidental finding endoscopy, most benign
general Causes of different categories of jaundice
Pre-hepatic - too much haem
Hepatic - reduced hepatocyte function
Post hepatic - obstructive causes
Red flags of jaundice
Hepatomgealy (irregular border)
Unintentional weight loss
Painless
Ascites + other symptoms (portal hypertension, damage to helatocytes, low albumin)
How is cancer of the liver normally caused?
Primary malignancy v rare e.g. hepatocellular, typically links to underlying disease
Portal system drains whole Gi tract so any malignant cells go through the liver - common site for metastases e.g. renal, prostate, lung, breast, skin - haematogenous spread or lymphatics (common in carcinomas - sentinal LN first one draining cancer) or spread from other systems e.g. ovarian - transcoelomic, breast, lung
Pancreatic cancer: symptoms, risk factors, prognosis
Malignancy to head -> obstruction and painless jaundice
Body/ tail obstruction - more vague symptoms related to pancreas function (digestion, glucose regulation)
Steatorrhoea- fatty, floating stools
80% ductal adenocarcinomas
Risk factors: FH, smoking, men, >60yrs, chronic pancreatitis
Prognosis V poor
Three key symptoms of lower GI malignancy
Obstruction
Per rectum bleeding
Change in bowel habit
General symptoms of obstruction in lower GI tract and red flags
Abdominal distension (small bowel >3cm, large >6, caecum >9 abnormal diameter)
Abdominal pain
Small bowel: nausea/ vomiting first
Large bowel: constipation first absolute (no faecal matter of flatulence)
🚩🚩
Unintentional weight loss, unexplained abdo pain then obstruction afterwards
Differential diagnosis of obstruction
Volvulus
Diverticula disease
Hernias
Strictures
Intussusception (one portion bowel slides into another- more children)
Pyloric stenosis (pyloric sphincter narrowed-> projectile vomiting bbys)
Malignancy in bowel
Differential diagnoses for Pr bleeding
Benign: haemorrhoids, anal fissures, infective gastroenteritis, IBD, diverticula disease
Malignant: small vs large bowel cancer
Red flags for Pr bleeding
> 50yrs
Iron deficient anaemia (slow accult bleeding)
Unexplained weight loss
Change in bowel habit
Tenesmsus (feeling need to poo then not fully emptying e.g. growth in rectum)
Symptoms of change in bowel habit
Change in frequency e.g. diarrhoea, constipation
Change in consistency e.g. more watery (overflow diarrhoea- caused by blackberries bowel)
Associated symptoms (bloating/ abdo discomfort)
Differential diagnosis for change in bowel habit
Depends on change
Benign: thyroid disorder, IBD, medication related, IBS, coeliac disease
Red flags for change in bowel habit
Older
Iron deficient anaemia
Unexplained weight loss
PR blood loss
Large bowel cancer: type, how common, risk factors, diagnosis
Adenocarcinomas
Third commonest cancer Uk
Risk factors: FH, IBD, polyposis syndromes e.g. familial adenocarcinomas polyposis/ HNPCC
Diet and lifestyle e.g. sedentary, high fibre, processed food, meat
Screening - faecal occult (hide ) blood samples if +ve colonoscopy + biopsy
How can polyps lead to adenocarcinoma?
Hyperproliferation -> adenomatous polyps -> severe dysplasia (precancerous polyps) -> adenocarcinoma -> invasive cancer
Symptoms of right sided colon cancer and most common location
Weight loss
Anaemia - occult bleeding
Less likely to have bowel obstruction
Mass right iliac fossa
Late change in bowel habit
More advanced disease at presentation
Fungating
Ascending colon especially caecum
Symptoms of left sided colon cancer and most common location
Weight loss
Rectal bleeding
Bowel obstruction
Tenesmus
Mass in left iliac fossa
Early change in bowel habit
Less advanced disease at presentation
Stenosing
Descending colon, narrowed present sooner
What sign do you often see on barium enema for colon cancers?
Apple core sign
Slide 42
Small bowel cancer: how common, types, risk factors, symptoms
V rare
Five types: Stromal tends benign, lymphoma, adenocarcinoma, sarcoma, carcinoid tumour (neuroendocrine features)
Risks: IBD, coeliac disease, FAP, diet
Symptoms: weight loss, abdo pain, blood in stools
How do you stage GI malignancy?
Dukes’ staging :
Dukes’ A: confined to inner lining mucosa
B: + affects musculature
C: + LNs affected
D: + metastatic spread
General management of Gi cancers
TNM staging
Blood tests- FBC, tumour markers e.g. CEA, CA19-9
CT/ MRI
Endoscopy/ colonoscopy - capsule endoscopy (random pics throughout tract)
Treatment ✅
Chemotherapy, radiotherapy, surgical resections e.g. bypass
