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GI > Malignancies > Flashcards

Malignancies Flashcards

0
Q

Investigations for oesophageal cancer?

A

Endoscopy and biopsy

Barium swallow

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1
Q

Clinical features of oesophageal cancer?

A

Progressively worsening dysphagia

Weight loss

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2
Q

Aetiology of oesophageal cancer?

A

Smoking
Alcohol

Squamous cell carcinoma - diet, iron deficiency, anaemia, high cereals, achalsia, HPV, vit A deficiencies

Adenocarcinoma - Barrett’s oesophagus, obesity, genetics

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3
Q

What achalsia?

A

Contraction of lower oesophageal muscles preventing food from entering the stomach

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4
Q

Where can squamous cell carcinoma and adenocarcinoma occur in the oesophagus?

A

Squamous cell - any level

Adenocarcinoma - metaplasia epithelium of Barrett’s oesophagus so lower down

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5
Q

Which is the most common type of oesophageal cancer?

A

Squamous cell carcinoma

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6
Q

What is the progression of dysplasia in oesophageal squamous cell carcinoma?

A

Squamous dysplasia to squamous cell carcinoma

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7
Q

What happens in Barrett’s oesophagus? Metaplasia or dysplasia?

A

Metaplasia (this is the abnormal change in nature of tissue)

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8
Q

What is dysplasia?

A

Enlargement of organ or tissue by proliferation of cells of an abnormal type. An early stage in development of cancer

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9
Q

Prognosis of oesophageal cancer?

A

Most present with advanced disease
Only 40% resectable
5% 5 year survival
Most die of bronchopneumonia as a result of aspiration due to dysphagia or oesophageal-broncho fistulae

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10
Q

Surgical management options of oesophageal cancer? (Palliative)

A

Can have a tube passed through the tumour to facilitate swallowing

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11
Q

What is leiomyoma?

A

Benign smooth muscle tumour
Squamous papilloma
Caused by HPV
Benign and rare

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12
Q

Aetiology of gastric cancer?

A 
Nitrates in diet
Smoking
H pylori infection
Genetics
Atrophy of stomach tissue eg after resection
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13
Q

Symptoms of gastric cancer?

A 
Dyspepsia (heartburn)
Weight loss
Anorexia
Bloatedness
Nausea and vomiting
Anaemia
Virchow's node
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14
Q

Investigations of gastric cancer?

A

Endoscopy and biopsy

Barium swallow

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15
Q

Most common type of gastric cancer?

Derived from what?

Which layers does it affect?

A

Adenocarcinoma
Derived from mucus-secreting cells
Early cancer confined to mucosa and submucosa
More advanced penetrate muscularis propria and become ulcerating

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16
Q

Macroscopic features of gastric cancer?

A

Fungating
Ulcerating
Infiltrative - linitis plastica (leather wine bottle)

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17
Q

Microscopic features of gastric cancer?

A

Intestinal - variable degree of gland formation

Diffuse - single cells and small groups, signet ring cells

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18
Q

What is the course of gastric cancer? (How it develops)

A

Chronic gastritis - atrophy - metaplasia - pre-malignant dysplasia - malignancy

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19
Q

What in gastric cancer is classed as early?

A

Even when spread to lymph nodes, still classed as early

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20
Q

How can gastric cancer spread?

A

Direct
Lymph nodes
Liver via hepatic portal vein
Trans-coelomic to peritoneum and ovaries

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21
Q

When can surgery not be used to treat gastric cancer?

A

If it is tethered to something like the aorta

If it is very widespread

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22
Q

What methods other than surgery can be used to treat gastric cancer?

A

Chemotherapy

Herceptin which targets the HER2 gene

23
Q

Where does gastric lymphoma originate?

A

MALT/GALT in the stomach (in lamina propria)

24
Q

What is gastric lymphoma strongly associated with?

A

H pylori
Eradication of H pylori early enough may lead to regression of the tumour
Better prognosis that gastric cancer

25
Q

Where are gastro-intestinal stromal tumours derived from?

A

Interstitial cells of Cajal (pacemaker cells for peristalsis)

26
Q

Treatment of gastro-intestinal stromal tumours?

A

Surgery
Imatinib following surgery if there is a mutation in C-kit gene. Can get rid of any remaining disease
Most are benign but can metastasise and recur

27
Q

How can gastro-intestinal stromal tumours be classified as benign or malignant

A

Look at pleomorphism, mitosis frequent and necrosis

28
Q

What are common tumours of the large intestine?

A 
Adenomas
Colorectal adenocarcinoma
Carcinoid tumour
Lymphoma
Smooth muscle/stromal tumours
29
Q

What are adenomas of the large intestine?

A

Benign, neoplastic lesions in the large bowel

Potential to become malignant

30
Q

Macroscopic am microscopic features of adenomas in the large intestine?

A

Macroscopic
-sessile or peduculated

Microscopic
-variable degree of dysplasia

31
Q

What genetic conditions increase the risk of adenomas in the large intestine?

A

Familial adenomatous polyposis - autosomal dominant, located on chromosome 5. Can have thousands of adenomas by 20. High risk of cancer

Gardner’s syndrome - similar to above. With bone and soft tissue tumours

32
Q

How does the adenoma lead to carcinoma?

A 
Oncogene activation
Mutation of tumour suppressor genes
Loss/suppression of DNA repair pathway
Takes 8-10 years
Carcinoma can grow in the adenoma
33
Q

Which is the most common GI malignancy in the UK?

A

Colorectal adenocarcinoma

34
Q

When is the peak incidence for colorectal carcinoma?

A

7th decade

60s

35
Q

Aetiology of colorectal adenocarcinoma?

A 
Family history
Age
IBD
Diet rich in fat and meat, low in fibre
Atherosclerosis
Diabetes
36
Q

Presentation of colorectal adenocarcinoma?

A 
Iron deficiency anaemia
Malaise
Weight loss
Vague abdominal pain
Faecal occult blood loss
Palpable mass
Recurrent UTI
Ascites
Sister Mary Joseph nodule
37
Q

How can colorectal adenocarcinoma spread?

A

Through bowel wall
Often infiltrates pelvic viscera and side walls
Lymphatic spread is common at presentation
Can reach the liver

38
Q

Which type of cancer is Duke’s staging used for?

A

Colorectal adenocarcinoma

39
Q

Give the Duke’s stages

A

A - confined to mucosa (5 year survival is 90%)
B - spread through all layers of mucosa to serosa
C - same as B + lymph node involvement
C1 - local lymph node involvement
C2 - distant lymph node involvement
D - widespread metastatic involvement

40
Q

Treatment of colorectal adenocarcinoma?

A

Tumour election for stages A-C
Radio and chemotherapy as adjuvants in B-C
Palliative in D
Resection of liver mets

41
Q

What is a carcinoid tumour of large intestine?

A

Rare endocrine tumour

42
Q

Risk factors of pancreatic cancer?

A 
Age (60+, rare under 40)
Smoking
Diabetes
Genetics
Obesity
H pylori
Partial gastrectomy
Male
43
Q

Symptoms of carcinoma of the pancreas?

A 
Pain
Anorexia
Nausea
Diarrhoea
Cachexia
Jaundice
Itchy
Trousseau' sign

Advanced

  • PE
  • diabetes
  • ascites
44
Q

Investigations for pancreatic carcinoma?

A 
Ultrasound
CXR - detects lung involvement
Endoscopy
Biopsy
CT/PET staging
45
Q

Treatment?

A

Normally palliative with analgesia

46
Q

What does pancreatic cancer normally look like?

A

Two thirds are in the head of pancreas
Firm, pale mass with necrotic centre
May infiltrate adjacent structures eg spleen

47
Q

Histology of pancreatic cancer?

A

80% are ductal adenocarcinomas
-well formed glands

Some acinar tumours contain zymogen granules

48
Q

What type of pancreatic cancer often has the best prognosis and why?

A

Carcinoma of the ampulla of Vater
Bile duct is blocked by the tumour so causes jaundice
Leads to early presentation when tumour is still treatable

49
Q

What cam islet cell tumours of the pancreas cause?

A

Insulinoma can cause hypoglycaemia

Glucagonoma can cause characteristic skin rash

50
Q

What benign tumours can you get of the liver?

A

Hepatic adenoma
Bile duct adenoma/hamartoma
Haemangioma

51
Q

What malignant liver cancers can you get?

A

Hepatocellular carcinoma
Hepatoblastoma
Cholangiocarcinoma

52
Q

What is the most common cancer in the liver?

A

Metastatic deposits

53
Q

What can be done to treat liver cancer?

A

Hemihepatectomy - liver regrows

54
Q

What is intestinal gastric cancer?

A 
H pylori in the stomach
Lymphocytes come along to deal with it (not normally present) and become resident in the stomach
So there is MALT in the stomach 
Which can become malignant
Precursor to gastric lymphoma

GI (21 decks)

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