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Gastro-intestinal System > Malignancy And Imaging > Flashcards

Malignancy And Imaging Flashcards

1
Q

What percentage of all cancers in the UK does oesophageal make up?

A

2%

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2
Q

Is oesophageal cancer more common in males or females?

A

Males

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3
Q

Name some symptoms/features of oesophageal cancer

A

Dysphagia
Progressively worsening
Weight loss

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4
Q

What investigations are necessary with oesophageal cancer?

A

Endoscopy

Biopsy

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5
Q

What is the most common type of oesophageal cancer?

A

Squamous cell carcinoma

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6
Q

Where in the oesophagus can squamous cell carcinoma occur?

A

Anywhere

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7
Q

Where are adenocarcinomas in the oesophagus occur?

A

Lower third

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8
Q

Give some causes of squamous cell carcinoma of the oesophagus

A 
HPV 
Tannin 
Vit A deficiency 
Riboflavin deficiency 
(Presumed progression through dysplasia)
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9
Q

What is the prognosis of oesophageal cancer?

A

Poor
At presentation most are advanced
Direct spread though wall

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10
Q

What percentage of oesophageal carcinomas are resectable on presentation?

A

40%

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11
Q

What is the 5 year survival rate for oesophageal carcinoma?

A

5%

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12
Q

What is the 5 year survival of gastric cancer?

A

< 20%

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13
Q

Is gastric cancer more common in men or women?

A

Men

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14
Q

What can gastric cancer be associated with?

A

Gastritis

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15
Q

Which blood group seems to get more gastric cancer?

A

A

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16
Q

What are the clinical features of gastric cancer?

A

Often vague
Epigastric pain
Vomiting
Weight loss

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17
Q

What investigations are needed for gastric cancer?

A

Endoscopy

Biopsy

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18
Q

What are the different macroscopic types of gastric cancer?

A

Fungating
Ulceration
Infiltrative
Early

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19
Q

Describe intestinal gastric cancer

A

Microscopic features

Variable degree of gland formation

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20
Q

Describe diffuse gastric cancer

A

Microscopic features
Single cell and small groups
Signet ring cells and full of mucin

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21
Q

Describe early gastric cancer

A

Confined to mucosa/sub-mucosa

Good prognosis

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22
Q

What is the 5 year survival of advanced gastric cancer?

A

10%

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23
Q

How can gastric cancer spread?

A

Direct (through gastric wall)
Lymph nodes
Liver
Transcoelomic - to peritoneum or ovaries

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24
Q

Describe Virchow’s nodes

A

Enlarged supraclavicular lymph nodes on same side as gastric cancer

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25
Q

What are the treatment options for gastric cancer?

A

Surgery
Chemotherapy (sometimes radiotherapy)
Herceptin - palliative

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26
Q

How come we can use Herceptin for some gastric cancers?

A

The same genetic abnormality is present in 10% of gastric cancers as is present in breast cancer
Amplification of HER-2 oncogene

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27
Q

What is the most common GI lymphoma?

A

Gastric lymphoma

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28
Q

What is gastric lymphoma strongly associated with?

A

H pylori infection

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29
Q

Is the prognosis for gastric lymphoma better or worse than gastric carcinoma?

A

Much better

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30
Q

Where do GI stromal tumour come from?

A

Derived from interstitial cells of Cajal
(Pacemakers cells for peristalsis)
Uncommon

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31
Q

What is the targeted treatment for GI stromal tumours and which other cancer do we use this treatment for?

A

Imatinib

Chronic myeloid leukaemia

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32
Q

Why are GI stromal tumours difficult to treat?

A

Unpredictable behaviour

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33
Q

What are the most common tumours of the large intestine?

A

Adenomas

Adenocarcinomas

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34
Q

Name the 4 different types of tumours of the large intestine

A

Adenoma
Adenocarcinomas
Polyps
Anal carcinoma

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35
Q

What is the difference between sessile or pedunculated adenomas?

A

Sessile - stalk

Pendunculated - no stalk

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36
Q

As age increases, incidence of adenomas …

A

Increases

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37
Q

Is the patient still at higher risk of cancer, even when adenomas are removed?

A

Yes

Large intestine will have a higher risk of cancer

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38
Q

Describe familial adenomatous polyposis

A

Autosomal dominant
Each mutation in families is slightly different
Will have thousands of adenomas by 20 years old
High risk of cancer

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39
Q

What is the common treatment for FAP?

A

Prophylactic colectomy

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40
Q

What is Gardner’s syndrome?

A

Similar to FAP

But also get bone and soft tissue tumours

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41
Q

What are synchronous lesions?

A

Lesions that develop at the same time in different places

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42
Q

What are metachronous lesions?

A

Lesions appearing at different times

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43
Q

What metabolic abnormality might people with adenomas present with?

A

Hypokalaemia

Adenomas can secrete lots of liquid rich in K+

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44
Q

What percentage of colorectal adenocarcinomas are rectosigmoid?

A

60-70%

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45
Q

What are the 2 types of adenocarcinoma and where do they commonly occur?

A

Fungating - right side

Stenotic - left side

46
Q

How can colorectal adenocarcinomas spread?

A

Direct through bowel wall
Via lymphatics
Via portal venous system

47
Q

Describe Dukes’ staging

A

Of colorectal adenocarcinomas
A = confined to bowel wall
B = through wall, lymph nodes clear
C = lymph nodes involved

48
Q

What is the different between C1 and C2 in Dukes’ staging?

A 
C1 = highest lymph node biopsied is clear
C2 = highest lymph node biopsied is involved
49
Q

What genetic abnormalities increase the risk of colorectal adenocarcinoma?

A

FAP
Ras mutations
DCC deletion
P53 loss/inactivation

50
Q

How does cetuximab work for bowel cancer?

A

Molecular therapy
Targets to RAS signalling pathway
Cannot use if they have a RAS mutation

51
Q

What is the most common age for bowel cancer?

A

60-70s

52
Q

What diseases is bowel cancer linked to?

A

Polyposis
UC
Crohn’s

53
Q

Give some causes of bowel cancer

A

Low fibre diet
Slow transit time
High fat intake
Genetic predisposition

54
Q

Describe carcinoid tumours

A

Rare endocrine tumour

Difficult to predict behaviour

55
Q

Why are pancreatic carcinomas difficult to diagnose?

A

Early symptoms are vague

Malaise, epigastric pain

56
Q

What symptoms/signs occur for pancreatic cancer?

A 
Epigastric pain 
Malaise
Weight loss
Jaundice
Trousseau's sign - thrombophlebitis
57
Q

How do we diagnose pancreatic cancers?

A

Via imaging

Biopsies are very difficult to do for the pancreas

58
Q

What proportion of pancreatic cancers occur in the head?

A

2/3

59
Q

Describe the morphology of pancreatic cancers

A

Firm, pale mass
Necrotic, haemorrhagic, cystic
May infiltrate adjacent structures eg. Spleen

60
Q

What type of cancer is most common in the pancreas?

A

Ductal adenocarcinomas

80%

61
Q

What is the histology of ductal adenocarcinomas?

A

Well formed glands

Mucin

62
Q

How might an insulinoma present?

A

Hypoglycaemia from too much insulin

63
Q

What is the classic sign of a glucagonoma?

A

Characteristic skin rash

64
Q

What are the commonest tumours of the liver?

A

Metastases

65
Q

Name some benign tumours of the liver

A

Hepatic adenoma
Bile duct adenoma
Haemangioma

66
Q

Name some malignant tumours of the liver

A

Hepatocellular carcinoma
Cholangiocarcinoma
Hepatoblastoma

67
Q

What 2 conditions is hepatocellular carcinoma associated with?

A

Cirrhosis

Viral hepatitis

68
Q

What is the radiation dose of USS and MRI?

A

None

69
Q

What is the radiation dose of any abdominal xray?

A

1 mSv

70
Q

What is the radiation dose of an abdo CT?

A

15 mSv

71
Q

What is the background radiation of the UK per year?

A

1 - 3 mSv

72
Q

What are the risks of radiation exposure?

A

Carcinogenesis
Genetic changes
Development problems in foetus

73
Q

Why would you request an abdominal x-ray?

A

Acute abdominal pain
Small/large bowel obstruction suspected
Acute exacerbation of IBD

74
Q

When is a hollow tube visible and not visible on an xray?

A

Visible = gas or gas and fluid filled

Not visible = fully fluid filled

75
Q

Why is the small intestine difficult to see?

A

Fast transit time therefore more fluid filled

76
Q

What are valvulae conniventes?

A

Bands that cross the entire wall of the small intestine

Thin

77
Q

How can we tell if the intestine you are looking at on xray is large bowel?

A

Peripheral position
Haustra
Faeces and gas (slower transit)

78
Q

Where can the transverse colon hang down to?

A

Pelvis

79
Q

A small bowel obstruction has to be wider than …

A

> 3 cm

80
Q

A large bowel obstruction has to be wider than …

A

> 6 cm

81
Q

Why can a competent ileocaecal valve become a problem?

A

Large bowel obstruction can cause increased pressure
Keeps building up against valve
Causes perforation

82
Q

What is the height of a vertebral body in a full grown adult?

A

3 cm

83
Q

What is the most common cause of small bowel obstruction?

A

Adhesions

Esp post operative

84
Q

Describe the presentation of small bowel obstruction

A

Vomiting (early)
Mild distension
Absolute constipation (late)
Colicky pain

85
Q

Give some causes of small bowel obstruction

A

Adhesions
Hernias (esp inguinal)
Tumours
Inflammation

86
Q

Large bowel obstruction is caused by what until proven otherwise?

A

Cancer

87
Q

Describe the presentation of large bowel obstruction

A

Vomiting (late)
Significant distension
Pain (not colicky)
Absolute constipation (early)

88
Q

Give some causes of large bowel obstruction

A 
Colorectal carcinoma 
Diverticula stricture
Hernia
Volvulus 
Pseudo-obstruction
89
Q

What imaging must we do for a large bowel obstruction?

A

CT of abdomen and pelvis with contrast

90
Q

What is a volvulus?

A

Twisting around mesentery cutting off blood supply

91
Q

What are some consequences of volvulus?

A

Perforation

Ischaemia

92
Q

Where is a volvulus most common?

A

Sigmoid colon

93
Q

How can we treat a volvulus?

A

Endoscopic untwisting

Surgery

94
Q

What is the gold standard imaging for infection or inflammation of abdomen?

A

Ultrasound

MRI

95
Q

What might you see on a AXR to do with inflammation/infection?

A

Mucosal thickening
Featureless colon (common in UC)
Bowel wall oedema

96
Q

What is toxic megacolon?

A

Acute deterioration of UC or colitis
Chronic dilation with oedema and pseudopolyps
Emergency
Requires a colectomy

97
Q

What is a lead pipe colon and what condition is it common in?

A

Featureless colon
Loss of haustra
UC

98
Q

What is thumb printing of colon?

A

Oedematous thickened haustra
Active inflammation
Often UC

99
Q

What type of xray are we most likely to see a pneumoperitoneum in?

A

Erect chest x-ray

Gas under the diaphragm

100
Q

Why do we use contrast studies for the GI tract?

A

Defines the hollow viscera

101
Q

What are the common GI contrast studies?

A

Swallow
Meal
Small bowel enema

102
Q

In whom is incomplete evacuation common?

A

Women after childbirth

103
Q

What do the levels of the CT correspond to?

A

Vertebral levels

NOT dermatomes

104
Q

What is a CT scan at L1 called?

A

Transpyloric plane

105
Q

What structures does the transpyloric plane pass through?

A 
Stomach pylorus 
Gall bladder
End of spinal cord
Neck of pancreas
Origin of SMA
Left and right colic flexures
Hilum of kidneys 
Root of transverse mesocolon 
Duodenojejunal flexure
1st part duodenum 
Spleen
106
Q

At what level does the aorta divide into the iliac vessels?

A

L4

107
Q

What are MRIs very good at?

A

Differentiating between different tissues

108
Q

Why are abdo USS good?

A

Cheap

Portable

109
Q

Why are abdo USS bad?

A

Highly user dependent

110
Q

How do we do a GI angiography?

A

Catheters into arteries to insert contrast then do 3 X-rays
1 plain
1 with contrast
1 delayed
To work out which vessels have the problem

Gastro-intestinal System (10 decks)

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