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Human Diseases Yr2 > Upper and lower GI cancers > Flashcards

Upper and lower GI cancers Flashcards

1
Q

What type of mucosal lining is found in the oesophagus?

A

Squamous cell mucosal lining

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2
Q

What type of mucosal lining is found in the stomach?

A

columnar epithelial lining

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3
Q

Where are most of the tumours of the oesophagus found?

A

Oesophago-gastric junction

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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.

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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)

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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.)

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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.

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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
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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

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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

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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)

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12
Q

What is the TNM method for staging cancers?

A

T - tumour size and depth?

N - malignant lymph nodes?

M - metastatic disease?

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13
Q

What is radical treatment?

A

Treatment with intent to cure the pt

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14
Q

What are some radical treatment options for oesophageal cancer?

A

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

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15
Q

What are the outcomes after oesophagectomy?

A

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

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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
Q

What is gardner’s syndrome?

A

Subtype of familial adenomatous polyposis.

  • pts may form osteomas (benign tumours of bone)
  • if seen must refer pt for further colonoscopic investigations
26
Q

What are some symptoms of colorectal cancer?

A

Melena

Change in normal bowel habit

Palpable lump

Tenesmus - feeling of incomplete rectal emptying

Weight loss

Pain

27
Q

How can we diagnose colorectal cancer?

A

Colonoscopy
Ct colonography
BARIUM ENEMA

28
Q

How can we stage colorectal cancer?

A

CT chest/abdomen/pelvis (to check spread to distal organs)

MRI rectum (rectal cancer only)

29
Q

What are the two classifications we an use to stage colorectal cancer?

A

TMN (size & depth, lymph, metastasis)

Duke’s staging

Staging depends on depth of bowel wall invasion, lymph node involvement and distant organ metastases.

30
Q

What are some radical treatments of colorectal cancer?

A

Pre-op chemotherapy
Resection (colonectomy)
Post op chemotherapy
Liver/lung resection

31
Q

What is some palliative care for colorectal cancer?

A

Stent
Palliative resection
Chemotherapy - in order to extend period of life.

32
Q

What ages are people in the UK screened for bowel cancer? How are they screened and what is the point of screening?

A

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

Human Diseases Yr2 (20 decks)

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