Other solid cancers

Question 1

Oesophageal

Answer 1

SCC in middle+upper 1/3: a/w smoking, alcohol, achalasia, low vit A
Adenocarcinoma in lower 1/3: a/w Barrett’s
Rare types like leiomyosarcoma + lymphoma

CF: often late with dysphagia, WL, odynophagia, hoarseness, upper abdo pain, reflux

Question 2

Gastric

Answer 2

Mostly adenocarcinoma

RF: male, H pylori, age, smoking, salt, high alcohol, FH, pernicious anaemia

CF: dyspepsia, dysphagia, N+V, melaena, haematemesis, WL, anaemia

Question 3

Liver

Answer 3

Hepatocellular carcinoma
95% in a cirrhotic liver
High alpha-fetoprotein

Question 4

Pancreatic

Answer 4

usually adenocarcinoma

Question 5

Biliary tract

Answer 5

intra or extra hepatic

cholangiocarcinoma: usually p/w jaundice

Question 6

Metastatic cancer of unknown primary

Answer 6

prognosis median of 12w

• usually adenocrciomas from pancreas or liver
• can be poorly differentiated like high grade lymphomas
• squamous cancers mostly present in cervical LN, usually with primary in the H+N or lungs; or if inguinal LN usually genital/anal area primary

Question 7

What Ix would you do for anyone with MCOUP?

Answer 7

• FBC, U+E, LFT, calcium, urinalysis, LDH
• CXR
• CT CAP
• AFP + hCG

Question 8

What Ix would you do for specific groups p/w mets of unknown origin?

Answer 8

• myeloma screen - lytic bone mets
• endoscopy
• PSA - all men
• CA 125 - women with peritoneal mets or ascites
• testicular US - men with germ cell tumours
• mammography - if BC possible