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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
What is gastric lymphoma strongly associated with?
H pylori Eradication of H pylori early enough may lead to regression of the tumour Better prognosis that gastric cancer
25
Where are gastro-intestinal stromal tumours derived from?
Interstitial cells of Cajal (pacemaker cells for peristalsis)
26
Treatment of gastro-intestinal stromal tumours?
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
How can gastro-intestinal stromal tumours be classified as benign or malignant
Look at pleomorphism, mitosis frequent and necrosis
28
What are common tumours of the large intestine?
``` Adenomas Colorectal adenocarcinoma Carcinoid tumour Lymphoma Smooth muscle/stromal tumours ```
29
What are adenomas of the large intestine?
Benign, neoplastic lesions in the large bowel | Potential to become malignant
30
Macroscopic am microscopic features of adenomas in the large intestine?
Macroscopic -sessile or peduculated Microscopic -variable degree of dysplasia
31
What genetic conditions increase the risk of adenomas in the large intestine?
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
How does the adenoma lead to carcinoma?
``` Oncogene activation Mutation of tumour suppressor genes Loss/suppression of DNA repair pathway Takes 8-10 years Carcinoma can grow in the adenoma ```
33
Which is the most common GI malignancy in the UK?
Colorectal adenocarcinoma
34
When is the peak incidence for colorectal carcinoma?
7th decade | 60s
35
Aetiology of colorectal adenocarcinoma?
``` Family history Age IBD Diet rich in fat and meat, low in fibre Atherosclerosis Diabetes ```
36
Presentation of colorectal adenocarcinoma?
``` Iron deficiency anaemia Malaise Weight loss Vague abdominal pain Faecal occult blood loss Palpable mass Recurrent UTI Ascites Sister Mary Joseph nodule ```
37
How can colorectal adenocarcinoma spread?
Through bowel wall Often infiltrates pelvic viscera and side walls Lymphatic spread is common at presentation Can reach the liver
38
Which type of cancer is Duke's staging used for?
Colorectal adenocarcinoma
39
Give the Duke's stages
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
Treatment of colorectal adenocarcinoma?
Tumour election for stages A-C Radio and chemotherapy as adjuvants in B-C Palliative in D Resection of liver mets
41
What is a carcinoid tumour of large intestine?
Rare endocrine tumour
42
Risk factors of pancreatic cancer?
``` Age (60+, rare under 40) Smoking Diabetes Genetics Obesity H pylori Partial gastrectomy Male ```
43
Symptoms of carcinoma of the pancreas?
``` Pain Anorexia Nausea Diarrhoea Cachexia Jaundice Itchy Trousseau' sign ``` Advanced - PE - diabetes - ascites
44
Investigations for pancreatic carcinoma?
``` Ultrasound CXR - detects lung involvement Endoscopy Biopsy CT/PET staging ```
45
Treatment?
Normally palliative with analgesia
46
What does pancreatic cancer normally look like?
Two thirds are in the head of pancreas Firm, pale mass with necrotic centre May infiltrate adjacent structures eg spleen
47
Histology of pancreatic cancer?
80% are ductal adenocarcinomas -well formed glands Some acinar tumours contain zymogen granules
48
What type of pancreatic cancer often has the best prognosis and why?
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
What cam islet cell tumours of the pancreas cause?
Insulinoma can cause hypoglycaemia | Glucagonoma can cause characteristic skin rash
50
What benign tumours can you get of the liver?
Hepatic adenoma Bile duct adenoma/hamartoma Haemangioma
51
What malignant liver cancers can you get?
Hepatocellular carcinoma Hepatoblastoma Cholangiocarcinoma
52
What is the most common cancer in the liver?
Metastatic deposits
53
What can be done to treat liver cancer?
Hemihepatectomy - liver regrows
54
What is intestinal gastric cancer?
``` 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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