Lecture 16- Lower GI cancer Flashcards
Symptoms of lower GI cancers:
- Obstruction
- PR bleeding
- Change in bowel habit
Obstructions
Anything that causing a blockage in the bowl
red flags associated with obstruction
- Weight loss
- Unexplained abdominal pain
General symptoms of obstruction
- Abdominal distension – how much air on x-ray
- Abdominal pain
benign causes of obstructions
- Volvulus- twisting of the bowel
- Diverticular disease
- Hernias
- Strictures
- Pyloric stenosis
- Intussusception – intestine slides inside another part
malignant causes of obstruction vary
based on location
small intestine malignancy and obstruction
- If obstructions higher up pressure builds up backwards vomiting first
small intestine malignancy and obstruction
- Would have to have very significant build up to cause vomiting
- Causes absolute constipation- no wind or faeces
PR bleeding Red flags
*
- Anyone 40 with unexplained weight loss /abdo pain should be considered
- > 50 with iron deficiency, anaemia and change in bowel habit
- Tenesmus- feeling the need to defaecate and defecating but still feel like there is something still there after finished
benign causes of PR bleeding
- Haemorrhoids
- Anal fissures
- IBD
- Diverticular disease
- Infective gastroenteritis
PR bleeding with S.intestine origin
melaena- more time to oxidise
PR bleeding with L.intestine origin
- Fresher bright red?
Change in bowel habits- Red flags
- Age dependent
- Weight loss
- Iron deficiency anaemia
change in bowel habits
- ‘What is normal for the patient?’*
- x
‘What is normal for the patient?’
- Change in frequency
- Change in consistency
- Associated symptoms
benign causes of change in bowel habits
- IBD
- Thyroid
- Coeliac
- IBS
- medication
large boweel cancer is the
2rd most common cancer in the UK
what type of cancer is large bowel cancer
adenocracinoma- polyp
large bowel cancer risk factor
- Risk factors
- Family history
- IBD
- Polyposis (FAP/ HNPCC)
large bowel cancer screening
- Screening program
- Faecal occult blood colonoscopy
- 60-75 yrs _ 2 years (one off at 55 years if available)
Familial adenomatous polyposis
FAP
- APC gene (tumour suppressor) mutation
outline how FAP can cause large bowel cancer
-
APC gene (tumour suppressor) mutation
- Starts as proliferation and gross
- Allows cells in intestinal wall to develop polyps
- Polyps can leads to dysplasia and malignancy adenocarcinoma
presentation of large bowel cancer depends on if it is
right sided or left sided
-
Right sided (ascending colon) – poor prognosis but treatable and manageable surgically
*
- Weight loss
- Anaemia
- Less likely to have bowel obstruction- lumen of ascending larger
- Liquid content (site of water reabsorption)
- Change in bowel habit is less likely
- More advanced disease at presentation
- Fungating –> grow out of the wall in one place (not concentrically)
- Left sided (descending colon)- better prognosis
- Weight loss
- Anaemia
- Bowel obstruction
- Narrower lumen
- Contents more solid
- Tenesmus
- Early change in bowel habit
- PR bleedings
- Less advanced disease t presentation
- Stenosing – concentrically make the lumen get smaller
- Apple core abnormality(barium enema)
small bowel cancer is
very rare
red flag for small bowel cancer
unexplained abdo pain
how many types of small bowel cancer
5
5 small bowel cancer
- Stromal (GIST)
- Lymphoma
- Adenocarcinoma
- Sarcoma
- Carcinoid (neuroendocrine)
symptoms of small bowel cancer
- Weight loss
- Unexplained abdo pain (more common in small bowel)
- PR bleeding
risk factors for small bowel cancer
-
Risk factors
- FAP
- IBD
- Coeliac
general investigations for lower GI cancer
- Endoscopy
- Colonoscopy
- Staging
-
Staging
- TNM staging
- Dukes staging (for malignancy of large bowel)
blood tests for lower GI cancer
-
Blood tests
- FBC – iron deficiency anaemia
- Tumour markers- CEA , CAL9-9
- Treatment for lower GI cancer
- Dependent on stage and age
- Curative = surgical intervention
- Non-curative= Symptomatic relief= surgery to relieve blockage- stoma
- If patient well enough- chemotherapy
