GI tumours

Question 1

What are the two types of oesophageal tumour (pathology)?

Answer 1

Adenocarcinoma and squamous cell carcinoma

Question 2

What part of the oesophagus does an adenocarcinoma usually affect?

Answer 2

The lower 1/3 of the oesophagus

Question 3

What is pre-malignant for oesophageal adenocarcinoma?

Answer 3

Barret’s oesophagus

Question 4

What is associated with oesophageal adenocarcinoma?

Answer 4

GORD (obesity)

Question 5

What part of the oesophagus does SCC affect usually?

Answer 5

Middle 1/3 of the oesophagus

Question 6

What is the mechanism for the formation of adenocarcinoma in the oesophagus?

Answer 6

Squamous ep. –> metaplasia (Barret’s oesophagus) –> dysplasia –> neoplasia (adenocarcinoma)

Question 7

What is SCC assoc. w/?

Answer 7

Smoking, excessive alcohol, HOT foods (coffee)…

Question 8

What does metaplasia mean? Give an example

Answer 8

The change in epithelium of one fully differentiated cell type to another fully differentiated cell type - e.g. Barrett’s oesophagus

Question 9

What are the symptoms of oesophageal cancer?

Answer 9

PROGRESSIVE DYSPHAGIA (first solids and then liquids), weight loss, chest pain, hoarse voice

Question 10

How would you diagnose oesophageal cancer?

Answer 10

Endoscopy + tumour biopsy

Question 11

What is the treatment for oesophageal cancer if it is local?

Answer 11

Pre-op CTx + RTx and surgical resection

Question 12

What is the prognosis for oesophageal cancer?

Answer 12

Poor

Question 13

Which country has a high prevalence of gastric cancer?

Answer 13

Japan

Question 14

What type of symptoms will be present in gastric cancer?

Answer 14

TARRY STOOLS, pain, dysphagia (if cardia), vomiting + outflow obstruction (pylorus), nausea, weight loss…

Question 15

What type of cancer is gastric cancer? Where does it normally affect?

Answer 15

Adenocarcinoma - the antrum

Question 16

What investigations would you do for gastric cancer diagnosis?

Answer 16

Endoscopy + biopsy

Question 17

What nodes are commonly palpable in gastric cancer?

Answer 17

Supraclavicular

Question 18

What two features might you find on examination for someone with gastric cancer?

Answer 18

Palpable epigastric mass and supraclavicular nodes

Question 19

What is associated with the development of gastric adenocarcinoma?

Answer 19

Pernicious anaemia, smoking, H. pylori, pickles/preserved foods…

Question 20

What is associated with gastric lymphoma?

Answer 20

H. pylori infection

Question 21

Give 3 examples of small intestine tumours:

Answer 21

Carcinoid (neuroendocrine tumour), adenocarcinoma, NHL

Question 22

What do carcinoid tumours develop from? What do they secrete?

Answer 22

Enterochromaffin cells (secrete SEROTONIN,

Question 23

what is the 1st metastases site for small intestine tumours/

Answer 23

Liver (through the portal vein)

Question 24

How would you investigate carcinoid tumour

Answer 24

5HIAA in the urine, liver mets (USS)

Question 25

What is the treatment for carcinoid tumour?

Answer 25

5-HT antagonist (cyproleptadine), RTx, surgical resection...etc

Question 26

What is pre-malignant for pancreatic cancer?

Answer 26

Chronic pancreatitis

Question 27

What are the commonest pancreatic cancers?

Answer 27

Adenocarcinoma of the pancreatic ducts

Question 28

What clinical features would be present if the pancreatic cancer is at the head of the pancreas or ampulla of vater?

Answer 28

Jaundice, scratch marks, Distended gall bladder, central abdominal mass, weight loss

Question 29

What clinical features would be present if the pancreatic cancer is in the body or tail of the pancreas?

Answer 29

Weight loss, anorexia, abdominal pain (epigastric)

Question 30

What are the general features of pancreatic cancer?

Answer 30

DM, weight loss, epigastric pain, central abdominal mass, anorexia

Question 31

What tumour marker is raised in pancreatic cancer?

Answer 31

CA19-9

Question 32

What investigations would you carry out to diagnose pancreatic cancer and what would you see?

Answer 32

Serum tumour marker CA19-9 ^ ERCP for cytology USS (dilated bile ducts + mass lesion) - same with CT scan

Question 33

What are most intestinal polyps?

Answer 33

Adenomas

Question 34

What is an adenoma?

Answer 34

A benign neoplasm of glandular epithelium

Question 35

What is the precursor lesion for an colorectal cancer?

Answer 35

Adenoma polyps

Question 36

What is are the causes of adenomatous polyps?

Answer 36

``` Most = idiopathic 5% = Family colon cancer sydromes (HNPCC and FAP) ```

Question 37

Which family colon cancer syndrome has 100% risk of getting colorectal cancer?

Answer 37

FAP

Question 38

What are the risk factors for developing colorectal cancer?

Answer 38

HNPCC, FAP, FHx of colorectal cancer, increase in age, diet high in meat but low in fibre

Question 39

What is the commonest colorectal cancer pathology?

Answer 39

Adenocarcinoma

Question 40

In which region of the large intestine do most tumours occur?

Answer 40

L side

Question 41

What criteria is used to stage colorectal cancer?

Answer 41

TNM or Duke's criteria

Question 42

Do all adenomatous polyps develop into adenocarcinomas? What happens if one is seen on endoscopy?

Answer 42

No - most don't. If seen on endoscopy it is removed

Question 43

What are the symptoms of colorectal cancer?

Answer 43

CHANGE IN BOWEL HABIT, Rectal bleeding, weight loss, lethargy, malaise, INTESTINAL OBSTRUCTION (colicky pain and constipation)

Question 44

What are the signs of colorectal cancer?

Answer 44

Distension (abdomen), palpable mass

Question 45

What is the gold standard investigation for colorectal cancer?

Answer 45

Colonoscopy with biopsy

Question 46

What blood tests would you do to investigate colorectal cancer?

Answer 46

FBC (anaemia), tumour marker (^), LFTs (liver mets = abnormal LFTs)

Question 47

What radiological investigations would you do?

Answer 47

PET scan, CT (chest, abdo and pelvis)

Question 48

What tumour marker is raised in colorectal cancer?

Answer 48

CEA (carcinoembryonic antigen)

Question 49

Describe the screening programme for colorectal cancer in the UK

Answer 49

M + W (60-74); biannual (2x/yr) faecal occult blood test; if +ve then colonoscopy indicated

Question 50

What part of the large colon is most affected by colorectal cancer?

Answer 50

Sigmoid colon + rectum