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General Surgery > Upper GI Cancer > Flashcards

Upper GI Cancer Flashcards

- Gastric cancer - Liver cancer - Pancreas cancer - Cholangiocarcinoma

1
Q

Epidemiology of Gastric cancer

A
  • 5th most common cancer
  • 2nd most common cause of death
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2
Q

Type of gastric cancer

A
  • Adenocarcinoma (90%)
  • lymphoid
  • connective tissue
  • neuroendocrine
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3
Q

RF of gastric cancer

A
  • Non modifiable
    • Male
    • Age
    • FHx
    • pernicious anaemia
    • Japan, china
  • Modifiable
    • H.Pylori
    • Smoking
    • Alcohol
    • Salty diet
      *
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4
Q
A
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5
Q

Where would gastric cancers normally appear?

A
  • antrum
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6
Q

What are the Sx of gastric cancer?

A

* majority present at advanced stage

  • dyspepsia
  • dysphagia
  • wt loss
  • anaemia
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7
Q

What signs will you find on cinical examination?

A
  • epigastric mass
  • Troisier sign - palpable Virchow’s node(left supraclavicular node)
  • Other signs of metastasis
    • hepatomegaly
    • ascites
    • jaundice
    • acanthosis nigricans
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8
Q

Differentials for Gastric cancer

A
  • PUD
  • GORD
  • Pancreatic cancer
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9
Q

What Ix would you order for gastric cancer?

A

Bedside

  • FBC
  • LFT
  • Clotting

Imaging

  • CXR - check for mets
  • CT chest abdo pelvis - staging

Special test

  • Urgent OGD - primary investigation
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10
Q

What are the NICE guidelines for urgent OGD referral

A
  • new onset dysphagia
  • >55 c weight loss
  • upper abdominal pain, reflux, dyspepsia
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11
Q

What is the Mx plan for Gastric cancer

A

Curative tx

  • Early Gastric Cancer (EGC) resection
  • partial gastrectomy - if distal
  • total gastrectomy - if proximal
  • Roux-en-Y for both
  • Endoscopic Mucosal Resection (EMR)

Palliative

  • Chemo
  • pyloric stenting
  • gasro-jejunostomy
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12
Q

What are the Cx for Gastric cancer

A
  • gastric outlet obstrction
  • iron deficiency anaemia
  • perforation
  • haematemesis, melaena
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13
Q

In liver cancer, which is more common, metastatic or primary?

A
  • Metastatic 90%
  • Primary 10%
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14
Q

What is the type of cancer in primary liver cancer?

A
  • Hepatocellular Carcinoma (HCC)
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15
Q

What is the epidemiology of HCC?

A
  • 6th most common cancer
  • 3rd cause of cancer death
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16
Q

What are the risk fctors for HCC?

A

Non modifiable

  • Age
  • FHx
  • Male

Modifiable

  • Hepatitis B & C
  • Chronic alcohol
  • Smoking
  • Aflatoxin exposure (toxic fungal metabolite found in cereal and nuts)
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17
Q

What are the ligaments of the liver?

A
  • Right coronary
  • Right triangular
  • Left coronary
  • Left triangular
  • Falciform
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18
Q

What are the clinical features of HCC?

A

* similar to liver cirrhosis

  • Fatigue, fever, weight loss
  • Ascites, jaundice
  • Dull RUQ pain - specific to HCC

On examintaion

  • irregular, craggy and tender liver
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19
Q

What are the differentials of HCC?

A
  • Hepatitis
  • Cardiac failure
  • Benign hepatocellular adenoma
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20
Q

What Ix would you order for HCC?

A

Bedside

  • FBC - low hb
  • LFT
  • Clotting test - pronlonged
  • alpha fetoprotein AFP - raised

Imaging

  • USS
  • CT - for staging
  • MRI

Special test

  • Liver biopsy - risk of tumour seeding
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21
Q

How would you diagnose HCC?

A
  • USS >2cm mass
  • AFP raised
22
Q

What staging syste would you use for HCC

A

Barcelona CLinic Liver Cancer (BCLC)

23
Q

WHat risk assessment tool you can use for liver cirrhosis and what does it measure?

A

MELD score

  • Creatinine
  • bilirubin
  • INR
  • sodium
  • use of dialysis
24
Q

What does the MELD score predict?

A
  • mortality from cirrhosis
  • likelihood of patient tolerating liver transplant
25
Q

What is the Mx for HCC?

A

Non surgical

  • image guided ablation - for early HCC (BCLC 0)
  • transarterial embolisation - for BCLC stage B

Surgical

  • Resection
  • Transplantation - must satisfy Milan criteria
26
Q

What is the Milan Criteria?

A
  • 1 lesion smaller than 5cm or 3 lesions smaller than 3cm
  • No extrahepatic manifestation
  • No vascular infiltration
27
Q

What cancers commonly metastasise to liver?

A
  • bowel
  • breast
  • pancreas
  • stomach lung
28
Q

What is cholangiocarcinoma

A

cancer of biliary system

29
Q

What is the biliary tree made of?

A
  • R&L hepatic ducts
  • Common hepatic duct
  • cystic duct
  • common bile duct
  • pancreatic duct
  • hepatopancreatic duct (ampulla of vater)
30
Q

Where is the most common location of cholangiocarcinoma?

A
  • birufication of R&L hepatic duct (Klatskin tumours)
31
Q

What cells bring rise to cholangiocarcinoma?

A
  • Cholangiocytes (95%)
  • squamous cell carcinoma
  • sarcoma (coonective tissue)
  • lymphoma
  • small cell carcinoma
32
Q

What are the RF for cholangiocarcinoma?

A
  • Intramural gallbladder wall calcification (porcelain gall bladder)
  • Primary sclerosing cholangitis
  • UC
  • Liver fluke, hepatitis
  • CHemicals in rubber and aircraft
  • Caroli’s disease
  • choledocal cyst
  • excess alcohol
  • DM
33
Q

What are the clinical features of cholangiocarcinoma?

A

*present at late stage

  • post hepatic jaundice
  • pruritis
  • pale stools, dark urine
  • other cancer related sx
34
Q

What will you find on examinatin for cholangiocarcinoma

A
  • jaundice
  • cachexia
  • Courvoisier’s law
35
Q

What is corvoisier’s law?

A
  • palpable enlarged gallbladder + jaundice = suspect malignancy of biliary tree as gall stone is unlikely
36
Q

What are the differentials for cholangiocarcinoma

*think things that cause post hepatic jaundice

A
  • primary sclerosing cholangitis
  • biliary cirrhosis
  • pancreatic tumours
  • beningn biliary tumours
  • bile duct strictures
  • gall stones
37
Q

What Ix would you order for cholangiocarcinoma

A

Bedside

  • Bloods
    • LFT - elevated bilirubin, ALP, yGT
    • CEA & CA19-9 - tumour markers

Imaging

  • USS
  • ​MRCP
  • ERCP
  • CT - staging
38
Q

What are the Mx options for cholangiocarcinoma?

A

Surgical

  • Comlete resection
  • partial hepatetctomy + reconstruction of biliary tree - Klatskin tumour
  • Whipple’s procedure - pancreaticoduodenectomy - for distal common duct tumours

Palliative

  • ERCP stenting
  • Bypass
  • raidotherapy
39
Q

What is Whipple’s procedure?

A
  • Removal of
    • head of pancrease
    • duodenum
    • gall bladder
    • bile duct
40
Q

What are the Cx of cholangiocarcinoma

A
  • Biliary tract sepsis
  • Secondary biliary cirrhosis
41
Q

What are the types of pancreatic cancer?

Where do they typically appear?

A
  • ductal adenocarcinoma (90%)
  • exocrine tumours - pancreatic cystic carcinoma
  • endocrine tumours - islet cells
  • Head (60%)
  • body (25%)
  • tail (15%)
42
Q

What is the epidemiology of pancreatic cancer?

A
  • 4th most common cause of cancer death
43
Q

Whar are the RF for pancreatic cancer?

A
  • Non modifiable
    • FHx
  • Modifiable
    • Chronc pancreatitis
    • Smoking
    • late onset DM >50
44
Q

How would pancreatic cancer present?

A
  • Obstructive jaundice (90%)
    • painless
  • Weight loss - due to exocrine dysfunction
  • Abdominal pain - invasion of celiac plexus
  • Acute pancreatitis
  • Thrombophlebitis sign
    • Red, swollen skin around effected site
      *
45
Q

What will you find on Ex on pt with pancreatic cancer?

A
  • Cachexia
  • Malnourished
  • Jaundice
  • Abdominal mass @ epigastric region
  • Enlarged gall bladder
  • Courvorsier’s law
46
Q

What is Courvoisier’s law?

A
  • In the presence of jaundice and palpable gallbladder, cholangiocarcinoma or pancreatic cancer should be suspected
47
Q

What are the differential diagnosis for pancreatic cancer?

A
  • Think about causes of obstructive jaundice
    • gall stones
    • cholangiocarcinoma
    • gall bladder stricture
  • Think about causes of epigastric pain
    • gallstones
    • PUD
    • gastric carcinoma
    • ACS
48
Q

What Ix would you order for pancreatic cancer?

A

Bedside

  • Bloods
    • Tumour marker: CA 19-9 - high sensitivity and specificity for pancreatic cancer
    • LFT: raised bilirubin, ALP, y-GT
    • FBC: anaemia

Imaging

  • USS: pancreatic mass, dilated biliary tree
  • CT abdo
  • CT chest-abdo-pelvis: staging
  • PET CT-scan

Special test

  • Endoscopic ultrasound (EUS)
  • ERCP
49
Q

How would you Mx pancreatic cancer?

A

Surgical

  • Whipple’s procedure - if head of pancreas
  • Distal pancreatectomy - if tail of pancreas

Chemotherapy

  • Adjuvant with 5 fluorouracil

Palliative care (most patients)

  • ERCP biliary stent
  • Enzyme replcament
50
Q

What is the prognosis of pancreatic cancer

A
  • 5 year survical rate <5%
51
Q
A

General Surgery (20 decks)

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