GI Malignancy Flashcards
How common is bowel cancer?
The 4th most common cancer in the UK
What are the 3 differential reasons for dysphagia? Which is the most likely to suggest malignancy?
Extramluminal - outside the lumen, compression from the lung and heart
Luminal - in the wall of the lumen, more likely to be malignant
Intraluminal - something stuck in the tube e.g. foreign bodies
What are the red-flags for dysphagia?
ALARM
- *A**naemia
- *L**oss of weight
- *A**norexia
- *R**ecent onset of Progressive symptoms
- *Masses/M**alaena
What is the usual type of cancer of malignancies in the oesophagus?
Squamous cell carcinoma
Why can the lower third of the oesophagus develop adenocarcinoma, despite the oesophagus normally being stratified squamous epithelium?
Barret’s oesophagus from GORD
Metaplasia from stratified squamous cells → columnar epithelium
Adenocarcinoma can therefore develop
What are the risk factors for oesphageal carcinoma?
- Smoking
- Barrett’s oesophagus
How does oesphageal carcinoma typically present?
Progressive Dysphagia
Food gets stuck but liquids can flow round the tumour
How would you investigate dysphagia?
Barrium swallow
See narrowing of the oesphagus from tumour
Also take biopsy
What are the red flags for gastric cancer?
- epigastric pain with…
- Malaena
- Haematemesis
What are some of the common non-cancerous causes of epigastric pain?
- Oesophageal varicies
- Gastric Ulcer
- Duodenal Ulcer
- Acute Gastritis
Which area of the stomach is most prone to gastric cancer?
The cardia or the antrum
What is the typical type of cancer in gastric cancer?
Adenocarcinoma
What are some of the risk factors for gastric cancer?
- Smoking
- High salt diet- causes irritation to stomach lining
- Family history
- Helicobacter Pylori
- Any form of chronic inflammation puts you at higher risk of malignancy
What is the prognosis of gastric cancer?
Generally poor
- 10% 5 year survival
- Increases to 50% after ‘curative’ surgery
Descibe Gastric Lymphoma
- Cancer of MALT tissue (muscus associated lymph tissue)
- Mostly associated with H. Pylori
- Prognosis better than gastric cancer
What kind of cancer are Gastrointestinal stromal tumours (GISTs)?
- Sarcomas (not epithelial) - soft tissue malignancy
- Tend to be an incidental finding on endoscopy
What are some of the red flag symptoms associated with jaundice?
- Hepatomegaly with irregular border
- Unintentional weight loss
- Painless
- Ascites
Is the main type of cancer in the liver?
Secondary metastasis from lung, breast, skin, renal, prostate
All metastasise to the liver due to the portal venous system
Primary malignancy, Hepatocellular carcinoma is rare
How does cancer spread to the liver?
- Haemotogenous spread via portal system
- Lymphatics - common in carcinoma
-
Spread from other systems
- ovarian- transcoelomic
- breast
- lung
How does the presentation of pancreatic cancer change dependent on whereabouts in the pancreas the tumour is?
- Head of pancreas - post hepatic jaundice (compresses common bile duct)
- Body/ Tail: symptoms more vague, realted to function of pancreas e.g. steatorrhea from lack of lipase
Give some risk factors for developing pancreatic cancer
- Family history
- Smoking
- Men > Women
- Incidence increaes with age >60
- Chronic pancreatitis
What are the 3 key symptoms of lower GI malignancy?
- Obstruction
- Per Rectum bleeding
- Change in bowel habit
What general symtpoms might a patient with obstruction in the lower bowel present with?
- Abdominal distension
- Abdominal pain
What diameter of the bowel is abnormal and would warrant further investigation?
Abnormal if:
- small bowel >3 cm
- large bowerl > 6cm
- caecum > 9cm
What are the differential diagnosis for bowel obstruction?
- Volvulus
- Diverticular disease
- Hernia
- Strictures
- Intusseception
- Pyloric stenosis
- Malignancy
How do symptoms of obstruction differ depending on whether the large or the small bowel is affected?
- small bowel (up to duodenum) will be nausea and vomiting
- Large bowel will be constiption (absolute i.e. can’t pass wind or fecal matter)
What red flag symptoms accompanying obstruction would suggest malignancy?
- unintentional weight loss
- unexplained abdominal pain
What are the differential diagnosis for PR bleeding?
- Haemorrhoids
- Anal fissues
- Infective Gastroenteritis
- Inflammatory bowel disease
- Diverticular disease
- Malignancy
What red flag symptoms can accompany PR bleeding?
- Age > 50 yrs send ASAP for investigation
- Iron deficiency anaemia
- Unexplained weight loss
- Change in bowel habit
- Tenesmus - feeling the need to evacuate bowels but not being able to do so due to blockage
What symptoms might a patient desribe for a change in bowel habit?
Change in frequency: Diarrhoea or constipation
Change in consistancy: more watery?
Associated symptoms: bloating or abdominal comfort
What are some of the differential diagnosis for a change in bowel habits?
- Thyroid disorder
- IBD
- Medication related
- IBS
- Coeliac disease
What red flag symptoms accompany a change in bowel habit?
- Age
- Iron deficient anaemia
- Unexplained weight loss
- PR bleeding
What kind of cancer is large bowel cancer?
Adenocarcinoma
What are the risk factors for develiping large bowel cancer?
- Family history
- Inflammatory bowel disease
- Polyposis syndroms e.g. FAP, HNPCC
- Poor diet
- Sedentary lifestyle
What screening programme exists to screen for large bowel cancer?
Faecal occult blood samples, checks for occult blood in stool
If positive, invited for colonoscopy
How can polyps develop to adenocarcinoma?
How does large bowel cancer present if it’s in the ascending colon (right sided)?
- weight loss
- anaemia from occult bleeding
- less likely to have bowel obstuction
- mass in right iliac fossa
- late changes in bowel habits
- more advanced disease at presentation
- Fungating - looks like a polpy on a stalk
How does large bowel cancer present if it’s in the descending colon (left sided)?
- weight loss
- rectal bleeding
- bowel obstruction
- tenesmus
- mass in left iliac fossa
- early change in bowel habits
- less advanced at time of presentation
- ‘stenosing’ - grows around the lumen
What is the apple coar sign?
A sign on imaging that shows stenosing tumours i.e. growth around the lumen
What are the 5 types of small bowel cancer?
- Stromal
- Lymphoma
- Adenocarcinoma
- Sarcoma
- Carcinoid tumours (of neuroendocrine secretions)
Give some risk factors for small bowel cancer
- IBD
- Coeliac disease
- FAP (Familial Adenomatous Polyposis)
- Diet
What are some of the symtpoms of small bowel cancer?
- unexplained weight loss
- abdominal pain
- blood in stools
How do you stage most of the GI tract cancers (except for the colon)
TNM staging
Which staging is used specifically for colon cancer?
Duke’s staging
