Upper and lower GI cancers Flashcards

1
Q

What type of mucosal lining is found in the oesophagus?

A

Squamous cell mucosal lining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What type of mucosal lining is found in the stomach?

A

columnar epithelial lining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where are most of the tumours of the oesophagus found?

A

Oesophago-gastric junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are adenocarcinomas and where in the oesophagus are they usually found?

A

They are malignant tumours which develop due to dysplasia of glandular and columnar epithelium at the distal end of the oesophagus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some risk factors for squamous cell carcinoma?

A

Smoking

Alcohol

Diet

Achalasia (nerve damage to the myenteric plexus which causes the LOS to stay tensed)

Leukoplakia (white patches on mucosal surfaces)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Adenocarcinoma risk factors?

A

Obesity - increased risk of GORD

GORD

Smoking

Alcohol

Barretts oesophagus (metaplasia of squamous cell epithelium to columnar epithelium which migrates upwards from gastro-oesophageal junction.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is barretts oesophagus and what is its correlation with oesophageal cancer?

A

Metaplasia of squamous cell epithelium to columnar cell epithelium which migrates upwards from the gastro-oesophageal junction.

Following from metaplasia there can by dysplasia which can result in an invasive carcinoma. (breaches basement membranes)

1-5% of ppl w/ barretts will develop oesophageal cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some signs and symptoms of oesophageal cancer?

A
Dysphasia
Indigestion or heartburn
Chest pain
Vomiting/regurgitation of food
Melena (blood in stool)
Haematemesis (vomiting blood) 
Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can we diagnose oesophageal cancer?

A

Medical history - dysphagia, weight loss, melena, haematemesis.

Examination of abdomen

Special investigations:
1st - endoscopy and biopsy

2nd - staging investigations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is an endoscopy?

What is an OGD?

A

Is the primary step in investigations for oesophageal cancer.

Allows direct visualisation and access for biopsy for tumours

Oesophago-gastro-duodenoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some methods of investigation in order to stage oesophageal cancers?

A

CT

Endoluminal ultrasound

Laparoscopy (examination of inside of abdominal cavity to check for spread of cancer outside oesophagus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the TNM method for staging cancers?

A

T - tumour size and depth?

N - malignant lymph nodes?

M - metastatic disease?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is radical treatment?

A

Treatment with intent to cure the pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some radical treatment options for oesophageal cancer?

A

Oesophagectomy alone
Pre-op chemo
Surgery, chemo, radio
Chemoradiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the outcomes after oesophagectomy?

A

Mortality - 5-10% short term
Morbidity - 25%
Median survival - 13.5 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How an we palliatively treat pts suffering from terminal oesophageal cancer who have dysphagia?

A

Endoscopic stent placement - keep oesophagus open
Tumour destruction
Palliative radiotherapy
Palliative chemotherapy

17
Q

What is the epidemiology of gastric cancer?

A

mainly males
>65 yrs old
poor socio-economic status
high incidence in far east

18
Q

What are some risk factors for gastric cancer?

A

Gastritis

Pernicious anaemia - deficiency in vitamin B12

Previous gastric surgery

Dietary factors (e.g. low fresh fruit)

Smoking

Blood group A

Family history

19
Q

What are some signs and symptoms of gastric cancers?

A
Dysphagia
persistent acid indigestion or heartburn (dyspepsia)
Chest pain
Vomiting/regurgitation of food
Melaena
Haematemesis
Weight loss
Feeling of persistent fullness after eating
20
Q

How can we diagnose gastric cancer?

A
History
Examination
Investigations
- endoscopy and biopsy
- staging CT, ultrasound, laproscopy
21
Q

What are some radical treatments for gastric cancer?

A

Total gastrectomy

Subtotal gastrectomy

22
Q

What are the outcomes of gastrectomy?

A

Mortality - 5%
Morbidity - 25%
5 yr survival - 10%

23
Q

What are some risk factors of colorectal cancer?

A

Age

Genetics and family history

Crohn’s and ulcerative colitis

Diet and lifestyle factors (red meat)

Obesity

smoking

Alcohol

24
Q

What is familial adenomatous polyposis?

A

It is a condition which is passed down through families

Causes the formation of lots of polyps in colon

These polyps may turn into cancer - so patients with familial adenomatous polyposis are screened often.

25
What is gardner's syndrome?
Subtype of familial adenomatous polyposis. - pts may form osteomas (benign tumours of bone) - if seen must refer pt for further colonoscopic investigations
26
What are some symptoms of colorectal cancer?
Melena Change in normal bowel habit Palpable lump Tenesmus - feeling of incomplete rectal emptying Weight loss Pain
27
How can we diagnose colorectal cancer?
Colonoscopy Ct colonography BARIUM ENEMA
28
How can we stage colorectal cancer?
CT chest/abdomen/pelvis (to check spread to distal organs) MRI rectum (rectal cancer only)
29
What are the two classifications we an use to stage colorectal cancer?
TMN (size & depth, lymph, metastasis) Duke's staging Staging depends on depth of bowel wall invasion, lymph node involvement and distant organ metastases.
30
What are some radical treatments of colorectal cancer?
Pre-op chemotherapy Resection (colonectomy) Post op chemotherapy Liver/lung resection
31
What is some palliative care for colorectal cancer?
Stent Palliative resection Chemotherapy - in order to extend period of life.
32
What ages are people in the UK screened for bowel cancer? How are they screened and what is the point of screening?
They are screened d60-74 yrs old They are screened using home testing kit which looks at faecal occult blood. Aim = detect disease in early stage. Stage 1 = 95% 5 yr mortality Stage 4 = 5% 5 yr mortality