S11) Gastrointestinal Cancers Flashcards
What are the differentials for a patient presenting with dysphagia?
- Extraluminal
- Luminal
- Intraluminal
In terms of upper GI cancers, what are the possible causes of a patient present with dysphagia?
- Benign causes
- Malignant causes – squamous cell carcinoma, adenocarcinoma
What are the red flags for dysphagia?
- Anaemia
- Loss of weight (unintentional)
- Anorexia
- Recent onset of progressive symptoms
- Masses/Malaena
What types of carcinomas are found in the GI tract?
- Stratified squamous epithelium in the oesophagus → squamous cell carcinomas
- Columnar epithelium in rest of GI tract → adenocarcinomas
Describe the clinical features of oesophageal carcinoma
- Typically present with progressive dysphagia
- Spread is common if presenting with symptoms
What are the risk factors for oesophageal carcinoma?
- Smoking
- Obesity
- Barrett’s oesophagus
What are the red flags for epigastric pain?
- Malaena
- Haematemesis
What is the differential diagnosis for a patient presenting with epigastric pain?
- Oesophageal varices
- Gastric ulcer
- Duodenal ulcer
- Acute gastritis
What are the clinical factors for gastric cancer?
- Adenocarcinomas typically in the cardia or antrum
- Present with similar pain to peptic ulcer
- 50% have a palpable mass
What are the risk factors for gastric cancer?
- Smoking
- High salt diet
- Family history
As a general note, which inflammatory response puts one at a higher risk of malignancy?
Chronic inflammation
What are some other forms of cancer which occur in the stomach?
- Gastric lymphoma
- Gastrointestinal stromal tumours (GISTs)
What are the clinical features of gastric lymphoma?
- Involves MALT tissue
- Similar presentation to gastric carcinoma
- Most associated with H. pylori
What are the clinical features of gastrointestinal stromal tumours?
- Sarcomas (not epithelial)
- Tend to be an incidental finding on endoscopy
What are the differentials for a patient presenting with jaundice?
- Pre-hepatic – too much haem
- Hepatic – reduced liver function
- Post-hepatic – obstructive causes
What are the red flags for jaundice?
- Hepatomegaly
- Ascites
- Painless
- Unintentional weight loss
What are the clinical features of liver cancer?
- Primary malignancy very rare
- Hepatocellular carcinoma typically links to underlying disease
Why do malignancies commonly metastasise to the liver?
⇒ The liver drains the entirety of the GI tract
⇒ Any malignant cells go through the liver
⇒ Therefore it is a common site for metastases
What malignancies commonly metastasise to the liver?
- Breast
- Colon
- Prostate
- Gastric
- Oesophageal
How do pancreatic cancers present?
- Head of pancreas: painless jaundice (Courvoisier’s law)
- Body/tail of pancreas: symptoms more vague
- 80% ductal adenocarcinomas
What does Courvoisier’s law dictate?
If a patient has large, palpable non-tender gallbladder, then the cause is not gall stones i.e. malignancy
What are the risk factors of pancreatic cancers?
- Family history
- Smoking
- Gender (men)
- Age (typically >60yrs)
- Chronic pancreatitis
What are the four symptoms of obstruction?
- Abdominal distension
- Abdominal pain
- Constipation
- Nausea and vomiting
What are the red flags for obstruction?
- Unexplained abdominal pain
- Unintentional weight loss
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
What are the symptoms of per rectum bleeding?
- Fresh bright red bleeding
- Melaena
- Anal pain
- Tenesmus
What are the red flags for per rectum bleeding?
- Iron deficient anaemia
- Unexplained weight loss
- Age dependant
- Change in bowel habit
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
What are the symptoms of a change in bowel habit?
- Change in frequency
- Change in consistency
- Bloating
- Abdominal discomfort
What are the red flags for a change in bowel habit?
- Iron deficient anaemia
- Unexplained weight loss
- Age dependant
- PR blood loss
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
Large bowel cancer is the third commonest cancer in the UK.
What sort of tumour is it?
Adenocarcinoma
What are the risk factors for large bowel cancer?
- Family history
- Inflammatory bowel disease
- Polyposis syndromes – FAP
- Diet and lifestyle
Ilustrate the phases involved in the progression of polyps to adenocarcinomas
Identify 4 symptoms of right sided colon cancer
- Weight loss
- Anaemia
- Occult bleeding
- Mass in right iliac fossa
Identify 5 symptoms of left sided colon cancer (sigmoid & rectum)
- Weight loss
- Abdominal pain
- Rectal bleeding
- Bowel obstruction
- Mass in left iliac fossa
Small bowel cancer is extremely rare.
Regardless, identify the 5 different types
- Stromal
- Lymphoma
- Adenocarcinoma
- Sarcoma
- Carcinoid tumours
What are the risk factors of small bowel cancers?
- IBD
- Coeliac disease
- FAP
- Diet
What are the symptoms of small bowel cancer?
- Weight loss
- Abdominal pain
- Blood in stools
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
What is the treatment for GI cancers?
- Chemotherapy
- Radiotherapy
- Surgical resections
