GI Malignancy: Oesophagus, Stomach, Pancreas, Colorectal Flashcards
Esophageal cancer Types -epidemiology -location -prognosis -risk factors
Adenocarcinoma (dysplasia => Barrets esophagus) - more common in West, UK/US
- most common in UK/US
- lower 1/3d
- better prognosis
- GORD, Barretts, smoking, achalasia, obesity, RT
Squamous cell cancer - more common in East, developing world
- upper 2/3d
- poorer prognosis
- smoking, alcohol. achalasia, nitrosamines
Older adults, increasing in incidence
Majority of risk factors are modifiable
Esophageal cancer
Presentation
Investigations
Dysphagia Anorexia, weight loss Vomiting, regurgitation of food, indigestion Cough Hoarse voice Melena
FIRST LINE - Upper GI endoscopy, biopsy
Staging CT of chest, abdo, pelvis for mets
Local USS for staging of non metastatic
Esophageal cancer
Management
-if operable
-palliative
If operable - surgical resection
-NAC + esophagectomy + AC
Palliation => radio, chemo, stenting of esophagus
Esophageal and stomach cancer
-2ww
Stomach and oesophageal cancer Dysphagia OR 55+ AND weight loss and any of the following: Upper abdo pain Reflux Dyspepsia
Stomach - LUQ mass
Stomach cancer
- epidemiology
- risk factors
Less common than colorectal, esophageal
Older males
-Japan, China, FInland, Colombia
- HPylori - inflammation of mucosa => atrophy and metaplasia
- atrophic gastritis
- pernicious anemia
- diet - salt, salt preserved, nitrates
- smoking
- blood group
Stomach cancer
- presentation
- investigations
- management
EG pain, indigestion Weight loss, anorexia N+V Dysphagia Hemoptysis Virchow Periumbilical nodule - Sister Mary Joseph
Diagnosis - endoscopy + biopsy
Staging - CT
Surgical - mucosal resection/gastrectomy
Chemo
Pancreatic cancer
- epidemiology
- type
- risk factors (environmental, genetic)
Increased incidence in older adults but often caught too late
Adenocarcinoma most common
Lifestyle - smoking, diabetes, chronic pancreatitis
Genetics - Lynch, MEN1, BRCA2, KRAS
Pancreatic cancer
- presentation
- investigations
- management
Painless jaundice + Courvoisier’s
-pale stool, dark urine, itch, cholestatic LFT
Anorexia, weight loss, EG/back pain
Loss of exocrine function => steatorrhoea
Loss of endocrine function => DM
Trousseau syndrome - migratory thrombophlebitis
Diagnosis - CT
Staging - CT CAP
Cancer marker - Ca19-9
Surgery - majority of cancers not suitable
-Whipple/pancreatodudenectomy if cancer in head + AC
Pallation - ERCP stent
Pancreatic cancer
-exocrine malignancies
Secretory tumours more likely to be benign
Non secretory => asymptomatic, more likely to be malignant but good prognosis
Insulinoma - most common, MEN1
-hypoglycemia, weight gain, high insulin, C peptide
VIPoma - stimulates pancreatic, intestinal secretion, inhibits acid and pepsinogen secretion
-diarrhoea, dehydration, lowK,Cl => weight loss
Glucagonoma
-DM, VTE, red blistering rash
Colorectal cancer
- epidemiology
- risk factors (environmental, genetic)
- protective factors
- most common locations
Majority of cancer - sporadic
Both of the following monitored with regular colonoscopy
-2nd most common - Lynch (HNPCC) - MSH, MLH => microsatellite instability
Amsterdam criteria
-3 family members
-2 gens
-1 diagnosis U50
- 3rd most common - FAP - APC
- total colectomy + ileoanal pouch if polyps found
KRAS, p53
UC
Modifiable risk factors
- Obesity - high sugar, alcohol
- Red/processed meat
Modifiable protective factors
- physical exercise
- Ca, garlic, fibre, non starchy veg/pulses
In order of prevalence - rectal, sigmoid, asc/cecum, transverse, desc
Colorectal cancer
- presentation
- how symptoms may differ depending on the site
- diagnosis
- tumour markers
Bowel habit changes - constipation, diarrhea, increased freq, straining Rectal bleed => Fe def anemia Abdo pain - bowel obstruction Weight loss UC, PSC Impact on other organs -ureter obstruction => urinary retention -fistula formation into bladder/stomach
Right - more liquid
-slow prolonged blood loss => Fe def anemia
-obstructive symptoms less common due to wider lumen
Left - more solid
-CHANGE IN BOWEL HABIT
-bowel obstruction => colicky pain from peristalsis against mass => straining, bloody stool, rectal mucous
Diagnosis - colonoscopy
Staging - CAP CT
-rectal cancer - mesorectal pelvic MRI
Tumour marker - CEA
Colorectal cancer
- colorectal management
- rectal management
Surgery for colorectal- hemicolectomy + lymphatic resection
-reattach bowel/stoma
Surgery for rectal
- local resection
- total mesorectal + LN excision
- anterior resection => attach sigmoid colon to remainder of rectum (temp ileostomy)
- abdoperineal resection => permanent stoma
NACR + ACR to reduce recurrence risk
Regular surveillance
Monoclonal AB to EGFR
Immune checkpoint inhibitors
Metastatic sites for GI cancers
Hematogenous spread is the most common
LIVER
LUNG
PERITONEUM
