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S11) Gastrointestinal Cancers Flashcards

1
Q

What are the differentials for a patient presenting with dysphagia?

A
  • Extraluminal
  • Luminal
  • Intraluminal
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2
Q

In terms of upper GI cancers, what are the possible causes of a patient present with dysphagia (problems swallowing)?

A
  • Benign causes
  • Malignant causes – squamous cell carcinoma, adenocarcinoma
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3
Q

What are the red flags for dysphagia and oesophageal cancers ?

A
  • Anaemia
  • Loss of weight (unintentional)
  • Anorexia
  • Recent onset of progressive symptoms
  • Masses/Malaena - this shows that there is a bleed high up as the blood has been digested and it looks dark and looks like tar
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4
Q

What types of carcinomas are found in the GI tract?

A
  • Stratified squamous epithelium in the oesophagus → squamous cell carcinomas
  • Columnar epithelium in rest of GI tract → adenocarcinomas
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5
Q

Describe the clinical features of oesophageal carcinoma

A
  • Typically present with progressive dysphagia (hard to swallow solids initially but fine with liquids and after a while its hard to swallow liquids)
  • Spread is common if presenting with symptoms
  • unexplained weight loss
  • squamous cell is common in upper ⅔res and adenocarcinoma is common is the lower ⅓

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6
Q

What are the risk factors for oesophageal carcinoma?

A
  • Smoking
  • Obesity
  • Barrett’s oesophagus (adenocarcinomas)
  • poor prognosis
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7
Q

What are the red flags for epigastric pain?

A
  • Malaena
  • Haematemesis (throwing up blood)
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8
Q

What is the differential diagnosis for a patient presenting with epigastric pain?

A
  • Oesophageal varices
  • Gastric ulcer
  • Duodenal ulcer
  • Acute gastritis
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9
Q

What are the clinical factors for gastric cancer?

A
  • Adenocarcinomas typically in the cardia (top) or antrum (bottom) of stomach
  • Present with similar pain to peptic ulcer
  • 50% have a palpable mass
  • similar presentation to oesophageal cancer
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10
Q

What are the risk factors for gastric cancer?

A
  • old/male
  • pernicious anaemia
  • Smoking
  • High salt diet
  • Family history
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11
Q

As a general note, which inflammatory response puts one at a higher risk of malignancy?

A

Chronic inflammation

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12
Q

What are some other forms of cancer which occur in the stomach?

A
  • Gastric lymphoma
  • Gastrointestinal stromal tumours (GISTs)
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13
Q

What are the clinical features of gastric lymphoma?

A
  • Involves MALT tissue
  • Similar presentation to gastric carcinoma
  • Most associated with H. pylori
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14
Q

What are the clinical features of gastrointestinal stromal tumours?

A
  • Sarcomas (not epithelial)
  • Tend to be an incidental finding on endoscopy
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15
Q

What are the differentials for a patient presenting with jaundice?

A
  • Pre-hepatic – too much haem
  • Hepatic – reduced liver function
  • Post-hepatic – obstructive causes
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16
Q

What are the red flags for jaundice?

A
  • Hepatomegaly
  • Ascites
  • Painless
  • Unintentional weight loss
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17
Q

What are the clinical features of liver cancer?

A
  • Primary malignancy very rare
  • Hepatocellular carcinoma typically links to underlying disease
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18
Q

Why do malignancies commonly metastasise to the liver?

A

⇒ The liver drains the entirety of the GI tract

⇒ Any malignant cells go through the liver

⇒ Therefore it is a common site for metastases

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19
Q

What malignancies commonly metastasise to the liver?

A
  • Breast
  • Colon
  • Prostate
  • Gastric
  • Oesophageal
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20
Q

How do pancreatic cancers present?

A
  • Head of pancreas: painless jaundice (Courvoisier’s law)
  • Body/tail of pancreas: symptoms more vague
  • 80% ductal adenocarcinomas

neuroendocrine are rare

some can secrete some hormones like insulin

Can suddenly get type 2 diabetes without having any obesity related risk factors

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21
Q

What does Courvoisier’s law dictate?

A

If a patient has large, palpable non-tender gallbladder, then the cause is not gall stones i.e. malignancy

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22
Q

What are the risk factors of pancreatic cancers?

A
  • Family history
  • Smoking
  • Gender (men)
  • Age (typically >60yrs)
  • Chronic pancreatitis
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23
Q

What are the four symptoms of obstruction?

A
  • Abdominal distension
  • Abdominal pain
  • Constipation
  • Nausea and vomiting
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24
Q

What are the red flags for obstruction?

A
  • Unexplained abdominal pain
  • Unintentional weight loss
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25
In terms of lower GI cancers, what are the differentials for a patient presenting with obstruction?
- **Benign**: I. Diverticular disease II. Volvulus III. Hernias - **Malignancy**: I. Adenocarcinoma large colon II. Small bowel cancer
26
What are the symptoms of per rectum bleeding?
- Fresh bright red bleeding - Melaena - Anal pain - Tenesmus (feeling you need to pass stool despite already pooing)
27
What are the red flags for per rectum bleeding?
- Iron deficient anaemia - Unexplained weight loss - Age dependant - Change in bowel habit
28
In terms of lower GI cancers, what is the differential diagnosis for a patient presenting with per rectum bleeding?
- **Benign**: I. Haemorrhoids II. Anal fissures III. Infective gastroenteritis IV. Inflammatory bowel disease V. Diverticular disease - **Malignancy**: I. Adenocarcinoma large colon II. Small bowel cancer
29
What are the symptoms of a change in bowel habit?
- Change in frequency - Change in consistency - Bloating - Abdominal discomfort
30
What are the red flags for a change in bowel habit?
- Iron deficient anaemia - Unexplained weight loss - Age dependant - PR blood loss
31
In terms of lower GI cancers, what is the differential diagnosis for a patient presenting with a change in bowel habit?
- **Benign**: I. Thyroid disorder II. Inflammatory bowel disease III. Medication related IV. Irritable bowel V. Coeliac disease - **Malignancy:** I. Adenocarcinoma of large bowel II. Small bowel cancer
32
Large bowel cancer is the third commonest cancer in the UK. What sort of tumour is it?
Adenocarcinoma
33
What are the risk factors for large bowel cancer?
- Family history - Inflammatory bowel disease - Polyposis syndromes – FAP - Diet and lifestyle
34
Ilustrate the phases involved in the progression of polyps to adenocarcinomas
35
Identify 4 symptoms of right sided colon cancer
- Weight loss - Anaemia - Occult bleeding - Mass in right iliac fossa
36
Identify 5 symptoms of left sided colon cancer (sigmoid & rectum)
- Weight loss - Abdominal pain - Rectal bleeding - Bowel obstruction - Mass in left iliac fossa
37
Small bowel cancer is extremely rare. Regardless, identify the 5 different types
- Stromal - Lymphoma - Adenocarcinoma - Sarcoma - Carcinoid tumours
38
What are the risk factors of small bowel cancers?
- IBD - Coeliac disease - FAP - Diet
39
What are the symptoms of small bowel cancer?
- Weight loss - Abdominal pain - Blood in stools
40
Which investigations are requested for a patient with a GI cancer?
- TNM staging - Bloods: FBC, tumour markers (CEA – carcino-embryonic antigen) - CT/MRI - Endoscopy/Colonoscopy - Capsule endoscopy
41
What is the treatment for GI cancers?
- Chemotherapy - Radiotherapy - Surgical resections
42
what doe Barretts oesophagus look like
43
what are some investigations and treatments for oesophageal cancer?
* Blood tests - anemia * OGD with biopsy to determine is its cancerous * CT to determine the stage Treatments: * Early: Endoscopic therapies * Mid: Oesophagectomy → removing parts of the oesophagus that is damaged * late stages: chemo
44
what are some investigations and treatments for oesophageal cancer?
* Blood tests - anemia * OGD with biopsy to determine is its cancerous * CT to determine the stage Treatments: * Early: Endoscopic therapies * Mid: Oesophagectomy → removing parts of the oesophagus that is damaged * late stages: chemo
45
common red flag symptoms that show gastric cancer
* unexplained weight loss * epigastric abdominal pain * lymphadenopathy * dysphagia *
46
what are some investigations and management of gastric cancer
* bloods (iron deficient anemia) * Gi endoscopy and biopsy to see if it is malignant * CT TREAT: - remove some or all of the stomach - chemo
47
what are some investigations and management for pancreatic cancer
* bloods → CA 19-9 is a maker for pancreatic cancer * CT * USS → can detect cancer arising in the head of the pancreas but not the body or the tai Treatment: - biliary stenting for jaundice * chemo
48
what is a Whipple surgery
when the head of the pancreas is removed
49
what is hepatocellular carcinoma
* most occur in patients with underlying cirrhosis or lover disease * right upper quadrant pain can be a symptom * 5 year survival rate
50
what are some investigations and management for hepatocellular carcinoma
* LFT's * prothrombin time (test synthetic function of the liver) * viral hepatitis panel * USS * CT * Liver biopsy can treat: resection or transplant or chemo
51
why is the liver a common site for metastasis
* highly likely that any GI malignancy Is going to spread to the liver * it has portal spread from other viscera * lymphatic
52
what is a cholangiocarcinoma and its normal clinical presentation
* bile duct cancer * painless jaundice, pruritis (itchy), dark urine and light coloured stool * poor prognosis
53
colorectal cancer and clinical presentation
adenocarcinomas from normal epithelium * blood In stool * severe: bowel restrictions perforation, abdominal pain and ascites * has a high prognosis
54
risk factors for colorectal cancer
* dietary factors * IBD * genetic
55
red flags in colorectal cancer
* blood In stool (red = more fresh and the issue is closer to the rectum) * iron deficiency * unexplained weight loss * mass on rectum * tenesmus (feeling like you want to empty stool despite not needing to) * patient will be constipated and soon solid can't pass due to obstruction and so they pass out diarrhoea but they haven't passed out all the stool
56
what are some differences between right and left sided colon cancer
LEFT: red blood RIGHT: occult means blood hidden in stool LEFT: narrowing of bowel RIGHT: fungating → ulcerations
57
what does the lumen of the bowel look like when there is a tumour blocking
58
what is the adenocarcinoma sequence
1. normal glandular epithelial cells → adenoma (begin neoplasm) → invasive carcinoma these are a series of mutations where oncogenes are switched on and the tumour suppressor genes p53 are switched off
59
what are some investigations and management of colorectal cancer
* stool test for blood * blood - for anemia * colonoscopy and CT management; - Remove some * chemo
60
anal cancer clinical symptoms
* perianal pruiritis or pain * bleeding discharge * mass like sensation * 70% cases can be cured with chemo

SA gastro-intestine (19 decks)

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