Neoplastic lesions Flashcards
Are SB neoplasms common?
No. Only 5% of GIT neoplasms.
What is the aetiology of SB neoplasms?
- inherited conditions
- immunocompromise (esp Kaposi sarcoma, adenocarcinoma and lymphoma)
- geographical location: middle east (? infectious agent)
- Crohn’s disease (increase SB adenocarcinoma)
What are the inherited conditions associated with small bowel neoplasms?
- Familial adenomatous polyposis (FAP): most neoplasms in duodenum
- Peutz-Jeghers Syndrome
- Gardner’s syndrome
What are the circumstances of immunocompromise facilitating SB neoplasms?
3 circumstances:
- Coeliac disease
- AIDS: liable to Kaposi sarcoma
- Immunosuppression: esp transplant patients
What is Peutz Jeghers syndrome?
Inherited condition associated with SB neoplasm. Intestinal polyps mainly in jejunum and marginal pigmentation around anal and buccal mucosa. Presentation usually with intussusception.
What is Gardener’s syndrome?
Inherited condition a/w SB neoplasms. Rare.
SB neoplasms associated with skeletal abnormalities and desmoid tumours.
What are the 4 most common cancers?
Lung, prostate, breast, CRC
RFx for CRC?
- Age >50
- Genetic (FAP, HNPCC, FHx)
- Colonic conditions (adenomatous polyps, IBD, PMHx CRC)
- Diet
- DM and acromegaly
Why are DM and acromegaly RFx for CRC?
Insulin and IGF1 are growth factors for colonic mucosal cells
CFx CRC?
- Often asymptomatic
- Haematochezia / melaena / change in bowel habit
- Anaemia Sx
- LoW/ palpable mass / obstruction
Where does CRC spread?
- Direct extension
- Lymphatic
- Haematogenous
Where does CRC usually met to?
- Liver (most common)
- Lung
- Bone
- Brain
Where may a tumour of the distal rectum metastasise to?
Tumour of distal rectum –> IVC –> lungs
Ix in CRC?
- Colonoscopy
- FBE/UEC/LFTs / CEA
- Staging Ix
What is CEA?
Carcinogenic embryonic antigen
Additional investigations in rectal cancer?
Pelvic MRI or endorectal US to determine T and N stage
Staging Ix in CRC?
- CT CAP
- Bone scan
- CT head only if lesions suspected
Rx of colon cancer?
- Wide surgical resection and regional LNs
- Adjuvant chemotherapy (5FU or oral capecitabine with oxaliplatin) can be considered for stage II or III
how is cancer bearing portion of colon removed in surgical excision?
According to vascular distribution of the segment
T staging of CRC?
T0 = no 1' tumour Tis = ca in situ T1 = invasion into submucosa T2 = invasion into muscular propria. T3 = invasion through muscularis propria and into series T4 = invasion into adjacent structures or organs
N staging of CRC?
N0= no nodal involvement N1 = 1-3 reg nodes N2 = 4+ regional nodes
M staging in CRC?
Binary
M0 = no distant met
M1 = distant met
