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SA gastro-intestine > S11) Gastrointestinal Cancers > Flashcards

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
Q

In terms of lower GI cancers, what are the differentials for a patient presenting with obstruction?

A
  • Benign:

I. Diverticular disease

II. Volvulus

III. Hernias

  • Malignancy:

I. Adenocarcinoma large colon

II. Small bowel cancer

26
Q

What are the symptoms of per rectum bleeding?

A
  • Fresh bright red bleeding
  • Melaena
  • Anal pain
  • Tenesmus (feeling you need to pass stool despite already pooing)
27
Q

What are the red flags for per rectum bleeding?

A
  • Iron deficient anaemia
  • Unexplained weight loss
  • Age dependant
  • Change in bowel habit
28
Q

In terms of lower GI cancers, what is the differential diagnosis for a patient presenting with per rectum bleeding?

A
  • 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
Q

What are the symptoms of a change in bowel habit?

A
  • Change in frequency
  • Change in consistency
  • Bloating
  • Abdominal discomfort
30
Q

What are the red flags for a change in bowel habit?

A
  • Iron deficient anaemia
  • Unexplained weight loss
  • Age dependant
  • PR blood loss
31
Q

In terms of lower GI cancers, what is the differential diagnosis for a patient presenting with a change in bowel habit?

A
  • 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
Q

Large bowel cancer is the third commonest cancer in the UK.

What sort of tumour is it?

A

Adenocarcinoma

33
Q

What are the risk factors for large bowel cancer?

A
  • Family history
  • Inflammatory bowel disease
  • Polyposis syndromes – FAP
  • Diet and lifestyle
34
Q

Ilustrate the phases involved in the progression of polyps to adenocarcinomas

A
35
Q

Identify 4 symptoms of right sided colon cancer

A
  • Weight loss
  • Anaemia
  • Occult bleeding
  • Mass in right iliac fossa
36
Q

Identify 5 symptoms of left sided colon cancer (sigmoid & rectum)

A
  • Weight loss
  • Abdominal pain
  • Rectal bleeding
  • Bowel obstruction
  • Mass in left iliac fossa
37
Q

Small bowel cancer is extremely rare.

Regardless, identify the 5 different types

A
  • Stromal
  • Lymphoma
  • Adenocarcinoma
  • Sarcoma
  • Carcinoid tumours
38
Q

What are the risk factors of small bowel cancers?

A
  • IBD
  • Coeliac disease
  • FAP
  • Diet
39
Q

What are the symptoms of small bowel cancer?

A
  • Weight loss
  • Abdominal pain
  • Blood in stools
40
Q

Which investigations are requested for a patient with a GI cancer?

A
  • TNM staging
  • Bloods: FBC, tumour markers (CEA – carcino-embryonic antigen)
  • CT/MRI
  • Endoscopy/Colonoscopy
  • Capsule endoscopy
41
Q

What is the treatment for GI cancers?

A
  • Chemotherapy
  • Radiotherapy
  • Surgical resections
42
Q

what doe Barretts oesophagus look like

A
43
Q

what are some investigations and treatments for oesophageal cancer?

A
  • 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
Q

what are some investigations and treatments for oesophageal cancer?

A
  • 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
Q

common red flag symptoms that show gastric cancer

A
  • unexplained weight loss
  • epigastric abdominal pain
  • lymphadenopathy
  • dysphagia
    *
46
Q

what are some investigations and management of gastric cancer

A
  • 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
Q

what are some investigations and management for pancreatic cancer

A
  • 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
Q

what is a Whipple surgery

A

when the head of the pancreas is removed

49
Q

what is hepatocellular carcinoma

A
  • most occur in patients with underlying cirrhosis or lover disease
  • right upper quadrant pain can be a symptom
  • 5 year survival rate
50
Q

what are some investigations and management for hepatocellular carcinoma

A
  • 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
Q

why is the liver a common site for metastasis

A
  • highly likely that any GI malignancy Is going to spread to the liver
  • it has portal spread from other viscera
  • lymphatic
52
Q

what is a cholangiocarcinoma and its normal clinical presentation

A
  • bile duct cancer
  • painless jaundice, pruritis (itchy), dark urine and light coloured stool
  • poor prognosis
53
Q

colorectal cancer and clinical presentation

A

adenocarcinomas from normal epithelium

  • blood In stool
  • severe: bowel restrictions perforation, abdominal pain and ascites
  • has a high prognosis
54
Q

risk factors for colorectal cancer

A
  • dietary factors
  • IBD
  • genetic
55
Q

red flags in colorectal cancer

A
  • 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
Q

what are some differences between right and left sided colon cancer

A

LEFT: red blood

RIGHT: occult means blood hidden in stool

LEFT: narrowing of bowel

RIGHT: fungating → ulcerations

57
Q

what does the lumen of the bowel look like when there is a tumour blocking

A
58
Q

what is the adenocarcinoma sequence

A
  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
Q

what are some investigations and management of colorectal cancer

A
  • stool test for blood
  • blood - for anemia
  • colonoscopy and CT

management;
- Remove some

  • chemo
60
Q

anal cancer clinical symptoms

A
  • 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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