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S3 GI > GI Malignancy > Flashcards

GI Malignancy Flashcards

1
Q

What are three categories for dysphagia, give examples?

A

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)

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2
Q

Red flags for dysphagia

A

ALARM

Anaemia (invading structures-> bleeding)

Loss of weight (unintentional)

Anorexia

Recent onset of progressive symptoms

Masses/ Malaena

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3
Q

What’s one sign dysphagia is neurological?

A

There will be difficulty swallowing liquids and solids simultaneously from the beginning

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4
Q

Oesophageal carcinoma type

A

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

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5
Q

Oesophageal carcinoma presentation, risk factors, prognosis, diagnosis

A

Typically progressive dysphagia

Risk factors: smoking, Barrett’s

Prognosis: 5% survival at 5 yrs

Diagnosis: barium swallow and OGD endoscopy + biopsy

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6
Q

What are the 9 quadrants of the abdomen for pain presentation, give some causes for each quadrant pain?

A

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)
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7
Q

Epigastric pain red flags

A

Malaena (black tar stool - altered blood coming from upper Gi tract)

  • haematemesis
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8
Q

Gastric cancer - location, type, presentation, risk factors, prognosis

A

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

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9
Q

Other cancers of the stomach bar gastric carcinoma

A

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

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10
Q

general Causes of different categories of jaundice

A

Pre-hepatic - too much haem

Hepatic - reduced hepatocyte function

Post hepatic - obstructive causes

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11
Q

Red flags of jaundice

A

Hepatomgealy (irregular border)

Unintentional weight loss

Painless

Ascites + other symptoms (portal hypertension, damage to helatocytes, low albumin)

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12
Q

How is cancer of the liver normally caused?

A

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

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13
Q

Pancreatic cancer: symptoms, risk factors, prognosis

A

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

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14
Q

Three key symptoms of lower GI malignancy

A

Obstruction

Per rectum bleeding

Change in bowel habit

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15
Q

General symptoms of obstruction in lower GI tract and red flags

A

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

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16
Q

Differential diagnosis of obstruction

A

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

17
Q

Differential diagnoses for Pr bleeding

A

Benign: haemorrhoids, anal fissures, infective gastroenteritis, IBD, diverticula disease

Malignant: small vs large bowel cancer

18
Q

Red flags for Pr bleeding

A

> 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)

19
Q

Symptoms of change in bowel habit

A

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)

20
Q

Differential diagnosis for change in bowel habit

A

Depends on change

Benign: thyroid disorder, IBD, medication related, IBS, coeliac disease

21
Q

Red flags for change in bowel habit

A

Older

Iron deficient anaemia

Unexplained weight loss

PR blood loss

22
Q

Large bowel cancer: type, how common, risk factors, diagnosis

A

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

23
Q

How can polyps lead to adenocarcinoma?

A

Hyperproliferation -> adenomatous polyps -> severe dysplasia (precancerous polyps) -> adenocarcinoma -> invasive cancer

24
Q

Symptoms of right sided colon cancer and most common location

A

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

25
Q

Symptoms of left sided colon cancer and most common location

A

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

26
Q

What sign do you often see on barium enema for colon cancers?

A

Apple core sign

Slide 42

27
Q

Small bowel cancer: how common, types, risk factors, symptoms

A

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

28
Q

How do you stage GI malignancy?

A

Dukes’ staging :

Dukes’ A: confined to inner lining mucosa

B: + affects musculature

C: + LNs affected

D: + metastatic spread

29
Q

General management of Gi cancers

A

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

S3 GI (16 decks)

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