GI Oncology Flashcards

Question

Signs of cancer in Head, neck and ulcinate process of pancreas?

Answer 1

- Obstructive Jaundice | - Dark urine and clay coloured stool

Answer 2

Back pain and weight loss

Answer 3

Smoking Occupation Rubber industry Benzidine dye industry (dry cleaning) Medical Diabetes mellitus Chronic pancreatitis Possible familial trend Diet High fat Lifestyle

Answer 4

-Usually advanced at time of diagnosis -Local spread: Throughout pancreas Duodenum, stomach, colon Obstructs common bile duct Blood: Liver via Portal vein and lung

Answer 5

- Adenocarcinoma-80% | - Islet tumour cells, acinar carcinoma and cystadenocarcinoma

Answer 6

- 50% diagnosed with distant mets - 60% in head - 25% in body and tail - 15% tail alone

Answer 7

- Resection is the only chance of cure | - Less than 20% resectable

Answer 8

Resection of head of pancreas+ duodenum, distal stomach, gallbladder and common bile duct

Answer 9

- High local failure - High mortality 5% - Difficult operation and long patient recovery

Answer 10

- Adjuvant therapy: - Chemo/EBRT - Chemo: gemcitabine and 5 fluoro uracil - Neo-adjuvant chemo 6-8 wks

Answer 11

``` Narcotics Coeliac plexus nerve blocks Biliary stenting (for jaundice) Drainage of ascites Palliative chemo Palliative RT (bone or brain mets) ```

Answer 12

ANT, POST, SUP-1.5-2cm covering coeliac axis, vertebral body pancreas motion should be taken into account 1.5-2cm with respiration.

Answer 13

Pancreas Conformal planning Minimise dose to Critical structures – both kidneys, liver, stomach, spinal cord & surrounding small bowel Radical (combination with chemotherapy gemcitabine or 5 FU – 45-50.4 Gy in 25-28# (1.8 Gy/# 5-5.5 weeks) Palliative – 30 Gy in 10#, 3 Gy/# in 2 wks

Answer 14

Acute:Nausea, diarrhoea and pain may - (Antiemetics and pain relief) Severe mucositis or even ulceration of the stomach or duodenum may occur. Maintaining adequate nutrition and hydration.

Answer 15

``` Concomitant chemotherapy - bone marrow suppression. Renal failure (rare – improper shielding?) ```

Answer 16

``` 5th most common cancer in the world More frequent in Asia than in Europe and USA Associated with chronic viral hepatatis Ageing population Obesity ```

Answer 17

-3 times more likely | Lower chance of surviving 21:33%

Answer 18

Presenting features: abdominal pain, weight loss If hepatic mass present: hepatic failure, ascites & other signs of chronic liver disease, alpha-fetoprotein (afp) is elevated in 50-70% of such patients

Answer 19

``` Primary hepatic cancers may be classified as: -unifocal exposure -infiltrating -multifocal Invade the portal vein-lungs ```

Answer 20

- Surgery is only chance of survival-20% resectable - Hepatectomy and transplant more widespread - chemo drug used Doxorubcin response rate of 10-20% - XRT and stereotactic may lead to 5-10% long term control

Answer 21

Must not exceed 30Gy to whole liver or radiation hepatitis | -EBRT and IMRT- individual metastases

Answer 22

Nausea and vomiting (5-HT antagonist antiemetics with or without steroids.) Bilirubin, prothrombin time and albumin must be monitored.

Answer 23

Primary biliary tumours- gall bladder and cholangiocarcinoma-arising from the ductal epithelium of the biliary tree

Answer 24

``` Equal incidence in male and female After age 65 Gallbladder lethal – 10% 5 year survival rate Chile, Japan & Northern India Gallstones , liver flukes ```

Answer 25

``` Right upper quadrant pain In advanced cases Nausea Vomiting Weight loss Obstructive jaundice Cancers of the biliary tree – obstructive jaundice ```

Answer 26

Usually arises in the body & rare in cystic duct (4%) Adenocarcinomas (85%) Anaplastic (6%) Squamous (5%) Spread – Lymphatic spread – coeliac & aortic nodes Hepatic mets, seed into peritoneum, invade liver

Answer 27

Cholangiocarcinoma Surgical resection only curative treatment – rare Palliative treatment – biliary stenting 5 year survival rate is 5% or less EBRT studies have shown some responses which increase survival rate

Answer 28

Surgical excision best chance Chemo-radiation shown to extend survival Intrabiliary stenting Less than 5% 5 year survival Combination cisplatin & gemcitabine –significant improvement for overall survival rates for patients

Answer 29

Nausea and vomiting Controlled with Anti-emetic With or without steroids