S8: GI cancers

Question 1

Describe the incidence of common cancers of the GI tract

Answer 1

Bowel most common
Pancreas
Oesophagus
Stomach
Liver

Question 2

Describe oesophageal cancer

Answer 2

Most malignancies in the oesophagus are squamous cell carcinoma
Lower 1/3 can develop adenocarcinoma (Barrett’s)
Typically present with progressive dysphagia
Risk factors: smoking & Barrett’s
Prognosis: poor

Question 3

List the red flags for dysphagia

Answer 3

Anaemia
Loss of weight 
Anorexia 
Recent onset of progressive symptoms 
Malaena (masses)

Question 4

Describe gastric cancer

Answer 4

Typically in the cardia/antrum
Adenocarcinomas
Present with similar pain to peptic ulcer
Risk factors: smoking, high salt diet, family history, H. pylori, increased age, male
Prognosis poor

Question 5

List other cancers that can occur in the stomach

Answer 5

Gastric lymphoma – MALT tissue, similar presentation to gastric carcinoma, most associated with H. pylori
Gastrointestinal stromal tumours – sarcomas, tend to be an incidental finding on endoscopy

Question 6

List the red flags for epigastric pain

Answer 6

Malaena

Haematemesis

Question 7

Describe liver malignancies

Answer 7

Primary malignancy (hepatocellular carcinoma) very rare 
Portal system drains the entirety of the GI tract -> any malignant cells go through the liver & therefore common site for metastases

Question 8

List the red flags for jaundice

Answer 8

Hepatomegaly – irregular border
Unintentional weight loss
Painless
Ascites

Question 9

Describe pancreatic cancer

Answer 9

Head: jaundice, body/tail: symptoms more vague
80% ductal adenocarcinomas
Risk factors: family history, smoking, men, increased age, chronic pancreatitis
Prognosis very poor

Question 10

List the three key symptoms in lower GI malignancy

Answer 10

Obstruction
Per rectum bleeding
Change in bowel habit

Question 11

Describe obstruction in lower GI malignancy

Answer 11

Small bowel: nausea/vomiting
Large bowel: constipation (absolute)
Red flags: unintentional weight loss & unexplained abdominal pain

Question 12

Describe PR bleeding in lower GI malignancy and the red flags

Answer 12

Look at nature of bleeding – mixed with stool? Fresh, bright red? Malaena?
Red flags: iron deficiency anaemia, unexplained weight loss, abdominal pain, change in bowel habit, tenesmus, mass on rectal examination

Question 13

Describe change in bowel habit in lower GI malignancy

Answer 13

Change in frequency, change in consistency & associated symptoms
Red flags: age dependent, iron deficiency anaemia, unexplained weight loss & PR blood loss

Question 14

Describe large bowel cancer

Answer 14

Adenocarcinoma
Risk factors: family history, IBD, polyposis syndromes, diet & lifestyle
Screening: faecal occult blood samples

Question 15

Describe the adeno-carcinoma sequence relating to colorectal cancer

Answer 15

Hyperproliferation 
Adenomatous polyps 
Severe dysplasia 
Adenocarcinoma – becomes malignant at this stage 
Invasive cancer

Question 16

Describe right sided colon cancer

Answer 16

Weight loss
Anaemia – occult bleeding 
Less likely to have bowel obstruction 
Mass in right iliac fossa
Late change in bowel habit 
More advanced disease at presentation – ‘fungating’

Question 17

Describe left sided colon cancer

Answer 17

Weight loss
Rectal bleeding
Bowel obstruction
Tenesmus (feeling you need to pass stools even though bowel is empty)
Mass in left iliac fossa
Early change in bowel habit
Less advanced disease at presentation – ‘stenosing’

Question 18

Describe small bowel cancer

Answer 18

RARE
Five different types – stromal, lymphoma, adenocarcinoma, sarcoma & carcinoid tumours
Risk factors: IBD, coeliac disease, FAP & diet
Symptoms: weight loss, abdominal pain & blood in stools

Question 19

Describe the diagnosis of GI cancers

Answer 19

Blood tests – FBC, tumour markers
Imaging – x-ray/fluoroscopy, CT/MRI
Biopsy – endoscopy/colonoscopy

Question 20

List staging methods for GI cancers

Answer 20

TNM

Duke’s staging – specifically for colorectal cancer

Question 21

Describe treatment for GI cancers

Answer 21

Depends on stage of tumours
Surgical resections 
Chemotherapy 
Radiotherapy 
Palliative