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GI System > Lower GI Malignancy > Flashcards

Lower GI Malignancy Flashcards

1
Q

List 3 key symptoms associated with Lower GI Malignancy

A
  • Obstruction
  • PR bleeding
  • Change in Bowel habit

Often need to look at these together

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2
Q

What are 2 general signs/ symptoms of bowel Obstruction

A
  • Abdominal pain

- Abdominal distension (Can be due to air/ faeces etc)

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3
Q

List 6 non-malignant causes of Bowel Obstruction

A
  • Intussusception (Bowel slides in on itself->narrows)
  • Hernias
  • Strictures
  • Volvulus (Loop of bowel twists around itself + its mesentery)
  • Diverticular disease
  • Pyloric stenosis
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4
Q

Malignant Bowel Obstruction can be in the Small or Large bowel.

How would these differ on presentation?

A

Small bowel obstruction;
- Nausea/ Vomiting

Large bowel obstruction;
- Constipation (Can be Absolute- no gas passed)

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5
Q

List 2 red flags for bowel obstruction

A
  • Weight loss

- Unexplained abdominal pain (Can’t treat/ identify cause etc)

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6
Q

List 5 non-malignant causes of PR Bleeding

A
  • Haemorrhoids
  • Anal fissure
  • Infective gastroenteritis
  • IBD
  • Diverticular disease
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7
Q

Malignant PR Bleeding can either be due to Small or Large Bowel Cancer.

How would small bowel cancer present?

A

Small bowel cancer;

  • Fresh
  • Bright red
  • Malaena
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8
Q

List the red flags for PR bleeding

A
  • Iron deficiency anaemia (40)
  • Weight loss (>40)
  • Change in bowel habit (>50)
  • Tenesmus (Feeling need to defecate after doing so, suggests cancer in Rectum)
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9
Q

What are 2 important components to asking about changes in bowel habit?

Suggest 2 associated symptoms to ask about

A
  • Changes in frequency
  • Changes in consistency (more watery)
  • Bloating
  • Abdominal discomfort
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10
Q

List 5 non-malignant causes of a change in bowel habit

A
  • Thyroid disorders
  • IBD
  • Medications
  • IBS
  • Coeliac Syndrome
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11
Q

Suggest 2 red flags for PR bleeding

A
  • Iron deficiency anaemia

- Weight loss

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12
Q

Describe Large Bowel cancer (3rd most common cancer in UK)

A
  • Tend to be Adenocarcinomas

- Tend to be due to Polyps changing to Adenoma

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13
Q

List 4 risk factors for Large Bowel Cancer

A
  • Family history
  • IBD
  • Diet + lifestyle
  • Polyposis syndromes (FAP, HNPCC)
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14
Q

How is large bowel cancer screened for?

Every 2 years in 65-70 year olds

A
  • Faecal Occult samples to test for small amounts of blood

- If +ve, patient referred for colonoscopy

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15
Q

Describe FAP including, how Polyps can change to Adenocarcinomas

(Familial Adenomatous Polyposis)

A
  • Autosomal dominant mutation in the TS gene, APC

- Leads to Polyp development on intestinal wall, which grow and become Adenocarcinomas by Dysplasia

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16
Q

Compare Right Sided (Ascending) and Left Sided (Descending) Colon Cancer with regards to;

  • Weight Loss + Anaemia
  • Bowel obstruction
  • Tenesmus
A

Right Sided (Ascending);

  • Weight loss + Anaemia
  • Bowel obstruction less likely (Bigger lumen, contents more liquid)
  • Tenesmus less likely

Left Sided (Descending);

  • Weight loss + Anaemia
  • Bowel obstruction
  • Tenesmus more likely
17
Q

Compare Right Sided (Ascending) and Left Sided (Descending) Colon Cancer with regards to;

  • Iliac Fossa mass
  • Change in bowel habit
  • Disease severity at presentation
  • Stenosing or Fungating
A

Right Sided (Ascending);

  • Mass in RIGHT iliac fossa
  • Late change in bowel habit
  • More advanced at presentation
  • ‘Fungating’ (grow outwards like fungi into lumen)

Left Sided (Descending);

  • Mass in LEFT iliac fossa
  • Early change in bowel habit
  • Less advanced at presentation
  • ‘Stenosing’ (Grows around periphery causing narrowing ‘Apple core’ sign)
18
Q

Is PR bleeding more likely in Left or Right sided colon cancer?

Compare the Prognosis in Left and Right

A

Left, has a better Prognosis as it is less advanced at presentation

19
Q

Small bowel cancer is very rare.

List the 5 types

A
  • Stromal
  • Lymphoma
  • Adenocarcinoma
  • Sarcoma
  • Carcinoid tumours (Neuroendocrine tumours in GI tract)
20
Q

List 3 symptoms of Small bowel cancer (Can vary widely)

A
  • Weight loss
  • Abdominal pain
  • Blood in stools
21
Q

List 4 risk factors of small bowel cancer

A
  • IBD
  • Coeliac disease
  • FAP
  • Diet

(Anything that can cause Polyp formation. E.g chronic inflammation)

22
Q

List 3 aspects of General Management of GI Malignancies

A

Investigation;

  • Endoscopy
  • Colonoscopy

CT/MRI for Staging;

  • TNM
  • Dukes (A, B, C, D)

Blood tests;

  • FBC
  • Tumour markers (CEA= Colorectal carcinoma, CA 19-9= Pancreatic tumour)
23
Q

What are 3 methods of treatment of GI Malignancies

A
  • Chemotherapy
  • Radiotherapy
  • Surgical Resections

GI System (26 decks)

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