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Session 8 Flashcards

1
Q

What is a carcinoma

A

Malignancy of cells that make up the epithelial lining of skin or tissue lining organs

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2
Q

What is an adenocarcinoma

A

Malignancy of glandular cells in epithelial tissue

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3
Q

What is an adenoma

A

Benign tumour formed from glandular structures in epithelial tissue

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4
Q

Incidence of GI cancers most common to least

A

Bowel
Pancreas
Oesophagus
Stomach
Liver

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5
Q

Features of oesophageal cancer histology

A

Usually squamous cell carcinoma
generally upper 2/3rds

Adenocarcinomas from columnar epithelium can occur in lower 1/3rd
Barrett’s oesophagus

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6
Q

Common clinical presentation of oesophageal cancer

A

Progressive dysphagia - Initially solids more difficult to swallow than fluids, this progresses until its hard to swallow liquids too

Odynophagia (pain on swallowing)

Unexplained weight loss

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7
Q

Oesophageal cancer red flags

A

ALARM

Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Malaena/Masses

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8
Q

Risk factors for oesophageal cancers

A

Squamous cell carcinomas- smoking, alcohol use, dietary intake e.g. hot beverages

Adenocarcinomas- obesity, reflux disease, most arise in background of Barrett’s oesophagus

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9
Q

Prognosis of oesophageal cancer

A

Prognosis is poor with 5% survival at 5 years

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10
Q

Investigations for oesophageal cancer

A

Blood tests- FBC (anaemia)

Oesophagogastroduodenoscopy (OGD) with biopsy (can help determine whether benign or cancerous cause)

CT thorax and abdomen (size of primary, local invasion, metastatic spread)

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11
Q

Treatment for oesophageal cancer

A

Dependent on stage

Endoscopic therapies (for limited disease)

Oesophagectomy (removal of oesophagus)

Chemoradiotherapy

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12
Q

histology of gastric cancer

A

Most commonly adenocarcinomas

Can get lymphomas, leimyosarcoma, neuroendocrine tumours

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13
Q

Where are gastric adenocarcinomas commonly found

A

Gastric cancer

gastric cardia most common, then antrum, then body of stomach

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14
Q

Classification of gastric cancer

A

Cardia gastric cancer- similar presentation to oesophageal cancer

Non cardia- arises in other parts of stomach

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15
Q

Types of gastric cancer

A

Lauren classification

Diffuse- younger patients, worse prognosis than intestinal type

Intestinal

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16
Q

Risk factors for gastric cancer

A
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17
Q

Most common clinical presentation of gastric cancer

A
  • Unexplained weight loss
  • Epigastric abdominal pain
  • Lymphadenopathy (Virchow’s node in left supraclavicular)
  • Dysphagia if cancer is located around cardia
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18
Q

Prognosis of gastric cancer

A

70% 5 year survival for local disease
5% if distant metastasis

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19
Q

Gastric cancer investigations

A

Bloods- looking for iron deficiency anaemia

Upper GI endoscopy and biopsy- for tissue diagnosis

CT CAP (chest, abdomen and pelvis, for staging)

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20
Q

Management of gastric cancer

A

Superficial- endoscopic mucosal resection

Localised- surgery to remove all or part of the stomach (gastrectomy) BUT if not suitable for surgery then chemo radiation

Advanced/metastatic- chemotherapy/immunotherapy and supportive care

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21
Q

Pancreatic cancer stats

A

8th leading cause of cancer death worldwide

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22
Q

Histology of pancreatic cancer

A

Pancreatic ductal adenocarcinoma is the main type

Pancreatic neuroendocrine tumours are rare and originate from the endocrine cells in the pancreas

They may be non-functional, or they may secrete hormones e.g. insulinoma = insulin

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23
Q

Risk factors for pancreatic cancer

A

Smoking
Chronic pancreatitis
Inherited mutations with BRCA 1/2, and PALB2 and with familial syndromes
Men > women plus increasing age

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24
Q

Classic clinical presentation

A

Painless jaundice, unexplained weight loss, can present with abdominal/back pain

New-onset type 2 diabetes mellitus in an adult over 50 years of age without any obesity-related risk factors

Changes to poo

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25
pancreatic cancer investigations
Bloods- LFTs if jaundiced, CA 19-9 CT- focused on pancreas can give very high diagnostic accuracy and can assess respectability in 80-90% USS- can detect cancer arising in the head with reasonable accuracy but not in the body or tail
26
management of pancreatic cancer
10-15% are suitable for surgical resection following by pancreatic enzyme replacement (only possible cure, 20% 5 year survival) Biliary stenting for jaundice Chemotherapy and symptom management if not resectable
27
Histology of hepatocellular carcinoma
Primary cancer arising from hepatocytes (usually with background of cirrhosis)
28
Risk factors for Hepatocellular carcinoma
Most HCCs occur in patients with underlying cirrhosis Many causes of cirrhosis including alcohol, Hep B and C
29
Hepatocellular carcinoma clinical presentation
Symptoms of liver disease can often mask the malignancy e.g. ascites, fatigue Acute hepatic decompensation or RUQ pain can be signs of development of HCC
30
Prognosis of hepatocellular carcinoma
5 year survival rate = approx 50% with complete surgical resection or liver transplantation Vs advanced HCC = median overall survival time with treatment approx 1 year
31
Investigations for hepatocellular carcinoma
Blood tests- LFTs, Prothrombin time/INR, viral hepatitis panel USS- non invasive and a good way to screen high risk individuals CT or MRI of abdomen Liver biopsy
32
Treatment of hepatocellular carcinoma
If suitable then ablation, resection or transplantation if not suitable, then chemotherapy/immunotherapy aims to slow tumour growth
33
Liver is a common site for metastases from
34
Routes for liver metastasis
Haematological e.g. portal spread from other GI viscera Lymphatic Spread via other routes e.g. ovarian = transcoelomic
35
Histology of cholangiocarcinoma
Bile duct cancers Majority are adenocarcinomas Can be intrahepatic or extrahepatic
36
Risk factors for Cholangiocarcinoma
Liver and bile duct diseases- cirrhosis, alcohol liver disease, non-specific bile duct diseases (bile duct adenoma), gallstones, PSC Infections High alcohol consumption Exposure to certain toxins/medications
37
Common clinical presentation of cholangiocarcinoma
Painless jaundice, pruritis, dark urine, light colour stool in extrahepatic due to biliary obstruction
38
Prognosis of cholangiocarcinoma
Poor prognosis 5 year overall survival rate in patients with metastatic disease is 2%
39
Colorectal cancer histology
Adenocarcinomas which progress from normal epithelium in a classical pattern
40
Risk factors for colorectal cancer
Dietary factors- high dietary fat, high red meat consumption, low dietary fibre, alcohol intake History of IBD genetic conditions: FAP familial adenomatous polyposis, and hereditary non polyposis colorectal cancer (HNPCC)
41
Colorectal cancer clinical presentation
Blood in stool and altered bowel habits Advanced = bowel obstruction or perforation or symptoms due to hepatic or peritoneal metastasis e.g. abdominal pain and ascites
42
Prognosis of colorectal cancer
Among gastrointestinal cancers, colorectal has the best overall prognosis For non-metastatic disease, the 5 year survival rate ranges from 50% to 95%
43
Colorectal cancer red flags
Blood in stool/rectal bleeding (not usually fresh or painful) Change in bowel habit (age, frequency, consistency) - Iron deficiency anaemia - Unexplained weight loss - Tenesmus (incomplete evacuation) - Mass on rectal exam
44
Features of right and left sided colon cancer
45
Adenocarcinoma sequence relating to colorectal cancer
46
Colorectal cancer investigations
Stool tests e.g. FIT Blood tests e.g. FBC for anaemia, CEA Colonoscopy and biopsy Imaging- CT, MRI
47
Management of colorectal cancer
Dependent on stage Surgery with pre or post operative chemotherapy/immunotherapy Chemotherapy/immunotherapy if not for surgical intervention
48
Bowel cancer screening
FIT test
49
Anal cancer histology
Typically squamous cell carcinomas
50
Risk factors for anal cancer
HPV infection HIV infection Engaging in anal-receptive sexual intercourse Chronic local inflammation due to IBD or recurrent anal fissures
51
Anal cancer clinical presentation
Local symptoms- parianal puritis or pain, bleeding, discharge and a mass like sensation
52
Prognosis of anal cancer
More than 70% of cases can be cured with chemo radiation Pap smear in high risk populations, and better prevention and treatment of HIV infection should lower the incidence
53
GI cancer staging
TNM T = size of primary tumour N = extent of regional lymph node involvement M = metastatic spread Stages 1-4
54
How can we stage colorectal cancer
Dukes’
55
Most stomach cancers are adenocarcinomas that arise from a
Chronic gastritis or metaplasia. Stomach ulcers are potentially malignant
56
What is the most common site for a primary gastrointestinal lymphoma
Stomach
57
What is the most important environmental factor in stomach cancer
H pylori
58
Why are most stomach cancers advanced
Present late
59
Pancreatic cancer generally affects those
Over 60 years old with no specific cause identified
60
What is the most affected portion of the pancreas
Pancreatic head
61
Why is it surprising that the small intestine is an uncommon site for adenomas and carcinomas
It’s large surface area and rapid cell turnover
62
Features of familial adenomatous polyposis
Inherited condition where invariably the numerous adenomas present will undergo malignant change
63
Colorectal cancers are related to several genetic events such as the
Activation of oncogenes Ineffective DNA repair Loss of tumour suppressor genes
64
Most colorectal cancers can be viewed with a
Sigmoidoscope
65
Rectal cancers are usually ulcerating and therefore give
PR bleeding
66
Why do rectal cancers produce tenesmus
Distension of the rectum
67
Staging of colorectal cancers relates to
How far the cancer has advanced through the abdominal wall, whether the lymph nodes are involved and the presence or absence of metastasis

GI (22 decks)

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