Intra-abdominal Cancer Flashcards by Beth Welch

Treatment for malignant hypercalcaemia?

Fluids and bisphosphonates.

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What are the key differentials for painless obstructive jaundice?

Pancreatic cancer or cholangiocarcinoma.

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New onset of diabetes or worsening of glycaemic control in T2D despite good lifestyle measures and medication can be an indicator of what?

Pancreatic cancer

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What is migratory thrombophlebitis?

Thrombophlebitis - blood vessels come inflamed with an associated thrombus in that area.
Migratory - thrombophlebitis reoccurring in different locations over time.

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What type of cancer is pancreatic cancer?

Adenocarcinoma

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Which is the most common part of pancreas to be affected by cancer?

Head

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Why does pancreatic cancer cause obstructive jaundice?

Tumour of head of pancreas compresses bile duct, obstructing flow of bile from liver.

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Name 3 risk factors for pancreatic cancer

Age, smoking and alcohol.

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What are the main symptoms of pancreatic cancer?

Painless jaundice (yellow skin and sclera, pale stools, dark urine and itching), upper abdominal/back pain, weight loss, steatorrhoea, N+V.

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What clinical signs would you see on a patient with pancreatic cancer?

Palpable epigastric mass, palpable gallbladder, jaundice.

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Define Courvoisers law

In the presence of jaundice and a palpable gallbladder, gallstones is unlikely, it is suggestive of pancreatic cancer or cholangiocarcinoma.

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What is Trousseau’s sign?

Migratory thrombophlebitis - sign of pancreatic cancer .

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What are the referral guidelines for suspected pancreatic cancer?

New onset jaundice in > 40 - 2 week wait referral.
Weight loss + additional symptom in > 60 (diarrhoea, back pain, abdominal pain, nausea, vomiting, constipation, new onset diabetes) - CT abdomen.

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What is the tumour marker for pancreatic cancer?

CA 19-9

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What investigations would you do for pancreatic cancer?

Bloods: FBC, U&Es, LFTs, clotting screen, bone profile.
CA 19-9.
CT chest, abdomen, pelvis.
MRCP.
ERCP - stent & biopsy.

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What type of surgeries can you do for pancreatic cancer?

Total pancreatectomy.
Distal pancreatectomy.
PPPD (modified Whipple).
Whipple procedure.

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What is a Whipple procedure?

Removal of head of pancreas, pylorus of stomach, duodenum, gallbladder, bile duct and relevant lymph nodes. AKA pancreaticoduodenectomy.

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What palliative treatments are there for pancreatic cancer?

Stents to relieve obstruction.
Surgery to bypass obstruction.
Chemotherapy.
Radiotherapy.

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What is the intervention of choice in patients with malignant distal obstructive jaundice due to unresectable pancreatic cancer?

Biliary stenting.

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What is the main risk factor for cholangiocarcinoma?

Primary sclerosing cholangitis.

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What is the tumour marker for cholangiocarcinoma?

CA 19-9

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Describe the clinical features of cholangiocarcinoma

Persistent biliary colic, anorexia, weight loss, jaundice, palpable mass in RUQ (Courvoisier sign), Sister Mary Joseph nodes, Virchow node.

Gastrectomy may result in what vitamin deficiency?

Vitamin B12

How might bowel cancer be identified?

Screening, incidentally on imaging or endoscopy, presentation of change in bowel habit, iron deficiency anaemia or bowel obstruction.

Where is colorectal cancer ranked in the UK for being the most common?

4th most common cancer.

What is the peak incidence of colorectal cancer?

85-89 years old.

List the risk factors associated with colorectal cancer

FHx, FAP, HNPCC, IBD, increasing age, diet high in processed/red meat, diet low in fibre, obesity, smoking, alcohol.

What does FAP stand for and what mutation is it?

Familial adenomatous polyposis. Mutation in APC tumour suppressor gene forming polyps (adenomas) in large bowel.

What does HNPCC stand for and what mutation is it?

Hereditary nonpolyposis colorectal cancer. Mutation in DNA mismatch repair genes, causing tumours (adenocarcinomas) to develop in isolation (no polyps).

What is the other name for HNPCC?

Lynch syndrome

What other cancer is HNPCC associated with?

Endometrial

Is sporadic or inherited form of colorectal cancer more common?

Sporadic

Mutations in which genes cause hyperproliferation of epithelium forming polys (adenomas), which eventually change into adenocarcinomas?

APC (tumour suppressor), p53 (tumour suppressor), KRAS (proto-oncogene).

Is left or right sided colorectal cancer more common?

Left sided - rectum and sigmoid colon.

What is the comet common site of metastatic spread in colorectal cancer?

Liver

Describe the clinical features of colorectal cancer

Change in bowel habit (diarrhoea/constipation). Weight loss. Rectal bleeding. Abdominal pain. Fatigue. Reduced appetite. Iron deficiency anaemia. Abdominal/rectal mass.

How does right sided vs left sided colorectal cancer typically present?

Right: iron deficiency anaemia. Left: change in bowel habit or bowel obstruction.

What is the criteria for a 2 week wait referral for suspected colorectal cancer?

> 40 with abdominal pain + weight loss. > 50 with unexplained rectal bleeding. > 60 with change in bowel habit or iron deficiency anaemia.

What is a FIT test?

Faecal immunochemical test (FIT), checks for human haemoglobin in stool.

When should a FIT test be used in GP?

> 50 with unexplained weight loss. < 60 with change in bowel habit.

Describe the bowel cancer screening program in England

Everyone aged 60-74 years screened every 2 years with home FIT test. Slowly expanding to 50-59 years. Positive FIT test —> colonoscopy referral.

What is the gold standard test for colorectal cancer?

Colonoscopy

What test can be used in patients unfit for a colonoscopy?

CT colonography

What is the tumour marker for bowel cancer?

CEA - used to measure risk of recurrence (not screening).

What is a right hemicolectomy?

Removal of caecum, ascending and proximal transverse colon.

What is a left hemicolectomy?

Removal of distal transverse and descending colon.

What is a high anterior resection?

Removal of sigmoid colon.

What is a low anterior resection?

Removal of sigmoid colon and upper rectum.

What is an abdomino-perineal resection (APR)?

Removal of rectum and anus (+/- sigmoid colon) and suturing over anus. Permanent colostomy.

What is Hartmann’s procedure?

Removal of rectosigmoid colon and suturing over rectal stump. Creation of temporary or pernamnet colostomy.

Describe the management of colorectal cancer

Surgery with neoadjuvant/adjuvant chemotherapy and radiotherapy.

What tests would you do to follow up a patient after curative bowel cancer surgery?

CEA and CT thorax/abdomen/pelvis.

Describe the guidelines for urgent 2 week wait referral for suspected pancreatic cancer

Patients aged >= 40 years with jaundice. Patents aged >=60 years with weight loss plus: diarrhoea, back pain, abdominal pain, nausea, vomiting, constipation or new-onset diabetes.

What is the diagnostic investigation of choice for pancreatic cancer?

High-resolution CT