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BRS Y1 > Week 11- GI Cancers > Flashcards

Week 11- GI Cancers Flashcards

1
Q

Define a cancer

A

A disease caused by uncontrolled cell division of abnormal cells in a part of the body

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2
Q

What is the difference between a primary and secondary cancer?

A

Primary: arises directly from the cells in the organ
Secondary: spread from another organ (eg via lmyph or blood)

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3
Q

What are the 2 types of epithelial cells in the GI tract?

A

Squamous

Glandular epithelium

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4
Q

What are the 2 types of neuroendocrine cells in the GI tract?

A

Enterocendocrine cells

Interstitial cells of Cajal

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5
Q

What are the 2 types of connective tissue cells in the GI tract?

A

Smooth muscle

Adipose tissue

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6
Q

What GI cancer arises from squamous cells?

A

Squamous Cell Carcinoma (SCC)

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7
Q

What GI cancer arises from glandular epithelium?

A

Adenocarcinoma

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8
Q

What GI cancer arises from enteroendocrine cells?

A

Neuroendocrine Tumours (NETs)

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9
Q

What GI cancer arises from interstitial cells of Cajal?

A

Gastrointestinal Stromal Tumours (GISTs)

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10
Q

What GI cancer arises from smooth muscle cells?

A

Leiomyoma/leiomyosarcomas

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11
Q

What GI cancer arises from adipose tissue cells?

A

Liposarcomas

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12
Q

What are the 3 parts of the oesophagus?

A

Cervical
Middle
Lower

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13
Q

What are the 2 main oesophageal cancers?

A

Squamous cell carcinoma

Adenocarcinoma

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14
Q

Describe oesophageal squamous cell carcinoma

A

From normal oesophageal squamous epithelium
Upper 2/3 of oesophagus
Acetaldehyde pathway
More common in the less developed parts of the world

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15
Q

Describe oesophageal adenocarinoma

A

From metaplastic columnar epithelium
Lower 1/3 of oesophagus
Associated with acid reflux
More common in developed parts of the world

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16
Q

How much does acid reflux increase the risk of oesophageal cancer?

A

30-100 times

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17
Q

What are the 3 stages of getting oesophageal cancer? What are the risks at each stage

A

Oesophagitis (inflammation)- 30% of UK pop
Barrett’s (metaplasia)- 5% of oesophagitis
Adenocarcinoma (neoplasia)- 0.5/1% lifetime risk per year

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18
Q

If a patient has Barrett’s how often should they have check ups?

A

No dysplasia evident= every 2/3 years
Low grade dysplasia= every 6 months
High grade dysplasia= intervention

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19
Q

How common is oesophageal adenocarcinoma?

A

9th most common cancer

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20
Q

Who does adenocarcinoma mainly affect?

A

The elderly

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21
Q

What is the male/female ratio for adenocarcinoma?

A

10:1

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22
Q

Describe survival rates for oesophageal cancer

A

Late presentation, mainly palliative care which is difficult to carry out, high morbidity and complex surgery

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23
Q

What is the 5 year survival for oesophageal cancer?

A

Less than 20%

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24
Q

How is oesophageal cancer diagnosed?

A

Endoscopy to get a biopsy

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25
Q

How is staging of oesophgeal cancer carried out?

A

CT scan and laparoscopy

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26
Q

Describe curative treatment for oesophageal cancer

A

Neo adjuvant chemo then radical surgery

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27
Q

Describe palliative care for oesophageal cancer

A

Chemotherpy, DXT, Stent

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28
Q

How is a oesophagectomy carried out?

A

Two stage Ivor Lewis approach

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29
Q

How common is colorectal cancer?

A

Most common GI cancer is western world

3rd most common cancer deaths in men and women

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30
Q

What is the lifetime risk of colorectal cancer for men and women

A

1/10 men

1/14 women

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31
Q

Who does colorectal cancer mainly effect?

A

Over 50 years old

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32
Q

What are the 4 forms of colorectal cancer? Explain them

A

Sporadic- no family history
Familial- family history, higher risk if family member was under 50 yrs and first degree relative
Hereditary syndrome- family history, FAP, HNPCC or Lynch syndrome
Histopathology- adenocarcinoma

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33
Q

What are risk factors of colorectal cancer?

A

Past history
Family history
Diet/ environmental- smoking, obesity etc

34
Q

Where are colorectal cancers found?

A

2/3 in descending colon and rectum

1/2 in sigmoid colon and rectum

35
Q

How do caecal and right sided cancers present?

A

Iron deficiency anaemia (most common)
Change in bowel habit (diarrhoea)
Late presentations: distal ileum obstruction, palpable mass

36
Q

How do left sided and sigmoid cancers present?

A 
PR bleeding, mucus
Thin stool (late presentation)
37
Q

How do rectal carcinomas present?

A

PR bleeding, mucus
Tenesmus
Anal, perianal and sacral pain

38
Q

What are late presentations of colorectal cancer?

A

Bowel obstruction
Local invasion: bladder symptoms, female genital tract symptoms
Metastasis: lung=cough, liver= hepatic pain/jaundice, regional lymph nodes

39
Q

What are signs of primary colorectal cancer?

A

Abdominal mass
Digital rectal mass
Rigid sigmoidoscopy
Abdominal tenderness and distension (large bowel obstruction)

40
Q

What are signs of metastasis and complications of colorectal cancer?

A

Hepatomegaly (mets)
Monophonic wheeze
Bone pain

41
Q

What are the 3 main investigative tests for colorectal cancer?

A

Faecal occult blood
Blood test
Double contrast barium enema

42
Q

Describe a faecal occult blood investigation

A

Based on pseudoperoxidase activity of haematin

Avoid red meat, horseradish, vit C and NSAIDs 3 days before test

43
Q

Describe blood tests as an investigation for colorectal cancer

A

FBC: anaemia, haematinics, low ferritin
Tumor markers: CEA
NOTE- not a diagnostic diagnostic

44
Q

Describe a double contrast barium enema investigation for colorectal cancer

A

Doesnt require sedation
More limited in detecting small lesion
All lesions still need to be confirmed by a colonoscopy and biopsy

45
Q

Describe a colonoscopy as an investigation

A

Can visualise lesions less than 5 mm
Small polyps can be removed to reduce cancer incidence
Performed under sedation

46
Q

Describe a CT colonoscopy as an investigation

A

Can visualise lesions greater than 5 mm
No need for sedation
Less invasive and better tolerated
Colonoscopy needed for diagnosis

47
Q

Describe an MRI of the pelvis for rectal cancer

A

Depth of invasion can be identified
No bowel prep or sedation needed
Helps choose between preoperative chemo or straight to surgery

48
Q

How is colon cancer mainly managed?

A

By surgery

49
Q

How is surgery on the right and transverse colon carried out?

A

Resection and primary anastamosis

50
Q

How is surgery on the right side carried out?

A

Hartmann’s procedure (proximal end colonoscopy)
Primary anastomosis (intraoperative bowel lavage and defunctioning ileostomy)
Palliative stent

51
Q

What is the most common form of pancreatic cancer?

A

Pancreatic ductal adenocarcinoma

52
Q

How is does pancreatic cancer often present?

A

80-85% late presentation

53
Q

What are survival rates of pancreatic cancer?

A

Median survival 6 months

5 year survival 0.4- 5%

54
Q

What age does pancreatic cancer mainly occour

A

Mostly 60-80%

55
Q

What are some risk factors for pancreatic cancer?

A 
Chronic pancreatitis
T2DM
Cholelithasis
Diet
Cigarette smoking
Family history
56
Q

What are some inherited syndromes accociated with pancreatic cancer risk?

A 
Hereditary pancreatitis
Familial atypical multiple mole melanoma
Peutz Jeghers syndrome
HNPCC
FAP
57
Q

Describe the pathogenesis of pancreatic cancer

A

Presence of pancreatic intraepithelial neoplasias

PDAs evolve through non invasive precursor lesions, they are microscopic (<5mm) and not visible via imaging

58
Q

What are clinical presentations of pancreatic cancer?

A

Jaundice
Weight loss
Pain (70 % at time of diagnosis)
GI bleeding

59
Q

What part of the pancreas do most pancreatic cancers arise in?

A

Head of the pancreas

60
Q

How are carcinomas in the body and tail of the pancreas different to the head?

A 
More advanced than lesions in the head at diagnosis
Marked weight loss
60% patients have back pain
Jaundice is uncommon
Most unresectable at time of diagnosis
61
Q

How is the tumor marker CA19-9 relevant in pancreatic cancer?

A

Falsely elevated in pancreatitis

Conc > 200 confer high specificity

62
Q

How is ultrasonography useful for pancreatic cancer?

A

Can identify pancreatic tumors
Can identify dilated bile ducts
Can identify liver metastases

63
Q

How is dual phase CT useful for pancreatic cancer?

A

Predicts respectability accurately in 80-90% of cases
Shows continguous invasion
Shows distant metasteses

64
Q

What imaging types are used for pancreatic cancer?

A

MRI- detects and predicts resectabilty accurately
MRCP- provides ductal images without ERCP complication
ERCP- confirms double duct sign, shows aspiration of the bile duct system, can be used therapeutically to biliary stent to relive jaundice

65
Q

What is EUS and how is it used in pancreatic cancer?

A

Detects small tumors, assesses vascular invasion

66
Q

How is laparoscopy used in pancreatic cancer?

A

Detects metastatic lesions of liver and peritoneal cavity

67
Q

What is a common feature of most patients with liver cancer?

A

Most of them have underlying cirrhosis

68
Q

What is the 5 year survival rate of liver cancer?

A

Less than 5%

69
Q

What are resection options for liver cancer?

A

OLTx
TACE
RFA

70
Q

How many people with liver cancer can have surgery?

A

5-15%

71
Q

What can increase risk of gallbladder cancer?

A

Gallstones
Porcelain gallbladder
Chronic typhoid infection

72
Q

What is the 5 year survival rate of gallbladder cancer?

A

Less than 5 %

73
Q

How many people with gallbladder cancer can have surgery?

A

Less than 15%

74
Q

What can increase risk of cholangiocarcinoma?

A

Liver fluke

Choledochal cyst

75
Q

What is the 5 year survival rate of cholangiocarcinoma?

A

Less than 5%

76
Q

How many people with cholangiocarcinoma can have surgery?

A

20-30%

77
Q

What is the 5 year survival rate of secondary liver metasteses?

A

0%

78
Q

What is 5 year survival with optimal surgical resection of primary liver cancer?

A

Over 30%

79
Q

What is 5 year survival with optimal surgical resection of gallbladder cancer?

A

Less than 15%

80
Q

What is 5 year survival with optimal surgical resection of cholangiocarcinoma?

A

20-40%

81
Q

What is 5 year survival with optimal surgical resection of secondary liver metastases?

A

25-50%

BRS Y1 (52 decks)

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