S11.1 GI Cancers

Question 1

What are some red flag symptoms of dysphagia?

Answer 1

ALARM

Anaemia, loss of weight, anorexia, recent onset of progressive symptoms, masses/malaena.

Question 2

What are some differentials for dysphagia?

Answer 2

Oesophageal carcinoma

Question 3

What type of cancer is oesophageal carcinoma?

Answer 3

Usually squamous cell carcinoma (associated with vitamin A deficiency, HPV), or adenocarcinoma (associated with Barret’s oesophagus)

Question 4

Describe the presentation and risk factors for oesophageal carcinoma

Answer 4

Presentation: progressively-worsening dysphagia with weight loss
Risk factors: smoking, obesity, Barrett’s

Question 5

Give some red flag symptoms of epigastric pain

Answer 5

Melaena, haematomesis

Question 6

Describe gastric cancers and their causes

Answer 6

Usually an adenocarcinoma in cardia or antrum

Associated with gastritis and blood group A

Question 7

What are the features and risk factors of gastric cancers?

Answer 7

Features: epigastric pain, vomiting, weight loss

Risk factors: smoking, high salt, family history

Question 8

Describe how gastric cancers can spread

Answer 8

Direct spread to liver, lymph nodes, ovaries.

Shall cause enlarged Virchows nodes

Question 9

Describe gastric lymphomas

Answer 9

Affects MALT tissue, prognosis better than adenocarcinoma

Strong association with H. pylori so eradicating this may lead to tumour regression

Question 10

Describe GI stromal tumours

Answer 10

Sarcomas (cancer of soft tissue not epithelia), involves pleomorphism, mitoses and necrosis.

Question 11

Give some red flag symptoms of jaundice

Answer 11

Hepatomegaly, ascites, painless, weight loss

Question 12

Why is the liver common site for metastasis?

Answer 12

Drains entire GI tract so common site for metastases such as those from breast, prostate, stomach and oesophagus

Question 13

What type of tumour causes pancreatic cancer?

Answer 13

Usually ductal adenocarcinoma

Can also have acinar tumours

Question 14

Give some symptoms and differentials of obstruction

Answer 14

Symptoms: abdo distension and pain, weight loss, constipation, vomiting
Differentials: hernia, volvulus, large/small bowel cancer

Question 15

Give some red flag symptoms and differentials of pre-rectal bleeding

Answer 15

Red flags: anaemia, weight loss, change in bowel habit

Differential: haemorrhoids, anal fissure, bowel cancer

Question 16

Give some red flag symptoms and differentials of a change in bowel habit

Answer 16

Red flags: anaemia, weight loss, pre-rectal blood loss

Differentials: thyroid disorder (overactive), inflammatory bowel disease, bowel cancer

Question 17

What type of tumour is large bowel cancer?

Answer 17

Colorectal adenoma which is then a precursor to colorectal adenocarcinoma (dukes staging)

Question 18

What are the risk factors and symptoms of large bowel cancer?

Answer 18

Risk factors: family history, IBD, polyposis syndrome, diet (low fibre)
Symptoms: left sided (weight loss, abdo pain, rectal bleeding), right sided (weight loss, anaemia)

Question 19

What types of tumours cause small bowel cancer?

Answer 19

Lymphoma, Stromal tumours, Sarcoma, Adenocarcinoma, Carcinoid tumour

Question 20

What are the risk factors and symptoms for small bowel cancer?

Answer 20

Risk factors: IBD, coeliac disease.

Symptoms: weight loss, abdo pain, blood in stools.