Lecture 17 GI malignancy Flashcards
Benign differentials of upper GI pathology
Dysphagia
Jaundice
Epigastric pain
Benign differentials of lower GI pathology
Change in bowel habit
PR bleeding
Bowel obstruction
Categories of dysphagia
Extraluminal - From outside
Luminal - inside wall
Intraluminal - inside lumen e.g. foreign body obstruction
Red flags for dysphagia
Anaemia Loss of weight Anorexia Recent onset of progressive symptoms Masses/maleana
Malignancies of GI
Oesophagus - Squamous cell carcinoma
Rest of GI tract - adenocarcinoma
Barret’s oesophagus
- GORD
- SSC - Columnar
- Adenocarcinoma
Oesophageal carcinoma
Presents with: progressive dysphagia
[common spread]
Risk factors: Smoking, Barret’s oesophagus
Prognosis: 5% survival at 5 years (poor)
Investigation:
Barium swallow - narrowing of oesophagus due to outgrowth
Endoscopic biopsy
Causes of epigastric pain
Oesophageal varices
Duodenal ulcer
Gastric ulcer
Acute gastritis
Can cause malaena or haematemsis
Gastric cancer
Adenocarcinoma in cardia or antrum
Similar pain to peptic ulcer with 50% having a palpable mass
RF: Smoking High salt diet Family history H pylori and gastric ulcers Chronic inflammation
Prognosis: 10% 5 year survival (poor)
Post curative surgery 50%
Other gastric cancers
MALT - gastric lymphoma
Gastrointestinal stromal tumours - sarcomas
Red flags for liver cancer
Jaundice Hepatomegaly - irregular border Painless Unintentional weight loss Ascites
Hepatocellular carcinoma
Primary malignancy rare
Portal vein drains GI therefore common site for metastases
Malignancies that commonly metastasis to liver
Prostate Breast Kidney Lungs Skin
Pancreatic cancer
Pancreatic head: Jaundice - obstruct common bile duct
Tail and body - vague symptoms- steatorrhoea due to decreased lipase release
Rapidly invasive - poor prognosis
RF for pancreatic cancer
Family history Male Smoker Age Chronic pancreatitis
Obstruction of lower GI tract
Abdominal distention - air Abdominal pain
Size of Intestines
Small bowel - 3cm
Large bowel - 6cm
Caecum - 9cm
Benign causes of lower GI obstruction
Hernia Diverticulum Volvulus Strictures Intussusception Pyloric stenosis
Intussusception
One part of bowel slides into another
Benign differentials for PR bleeding
Haemorrhoids Anal fissure Ulcerative cystitis Infective gastroenteritis Diverticula disease
PR bleeding types
Brigh red - sigmoid colon, rectum and anal canal
If dark and looks like maleana - colon
Red flags for PR bleeding
Age dependent - 50 + yrs Change in bowel habit Unexplained weight loss Tenesmus Iron deficient anaemia
Benign differentials for change in bowel habit
Thyroid disorder IBD Medication Infection IBS Coeliac disease
Red flags for change in bowel habit
PR bleeding
Age dependent
Unexplained weight loss
Iron deficient anaemia
Large bowel cancer
3rd most common cancer in UK
Adenocarcinoma
RF: Family history Polyposis - FAP Low fibre diet Inactive
Right sided large bowel cancer
- Weight loss
- Anaemia - occult bleeding
- Less likely for obstruction
- Right iliac fossa mass
- More advanced when presented
- Late change in bowel habit
- Fungating
Left sided large bowel cancer
- Weight loss
- Rectal bleeding
- Obstruction
- Left iliac fossa mass
- Less advanced when presents as narrower
- Early change in bowel habits
- Stenosing
Small bowel cancer types
Carcinoid Lymphoma Adenocarcinom Sarcoma Stromal
RF for small bowel cancer
Inflammatory bowel disease
FAP
coeliac disease
Symptoms of small intestine cancer
Weight loss
Abdominal pain
Haematochezia
Management of bowel cancer
Bloods - FBC and markers
CT/MRI
Endoscopy
TNM staging
Treatment of bowel cancer
Chemotherapy
Radio therapy
Surgical resection
