Week 11- GI Cancers Flashcards
Define a cancer
A disease caused by uncontrolled cell division of abnormal cells in a part of the body
What is the difference between a primary and secondary cancer?
Primary: arises directly from the cells in the organ
Secondary: spread from another organ (eg via lmyph or blood)
What are the 2 types of epithelial cells in the GI tract?
Squamous
Glandular epithelium
What are the 2 types of neuroendocrine cells in the GI tract?
Enterocendocrine cells
Interstitial cells of Cajal
What are the 2 types of connective tissue cells in the GI tract?
Smooth muscle
Adipose tissue
What GI cancer arises from squamous cells?
Squamous Cell Carcinoma (SCC)
What GI cancer arises from glandular epithelium?
Adenocarcinoma
What GI cancer arises from enteroendocrine cells?
Neuroendocrine Tumours (NETs)
What GI cancer arises from interstitial cells of Cajal?
Gastrointestinal Stromal Tumours (GISTs)
What GI cancer arises from smooth muscle cells?
Leiomyoma/leiomyosarcomas
What GI cancer arises from adipose tissue cells?
Liposarcomas
What are the 3 parts of the oesophagus?
Cervical
Middle
Lower
What are the 2 main oesophageal cancers?
Squamous cell carcinoma
Adenocarcinoma
Describe oesophageal squamous cell carcinoma
From normal oesophageal squamous epithelium
Upper 2/3 of oesophagus
Acetaldehyde pathway
More common in the less developed parts of the world
Describe oesophageal adenocarinoma
From metaplastic columnar epithelium
Lower 1/3 of oesophagus
Associated with acid reflux
More common in developed parts of the world
How much does acid reflux increase the risk of oesophageal cancer?
30-100 times
What are the 3 stages of getting oesophageal cancer? What are the risks at each stage
Oesophagitis (inflammation)- 30% of UK pop
Barrett’s (metaplasia)- 5% of oesophagitis
Adenocarcinoma (neoplasia)- 0.5/1% lifetime risk per year
If a patient has Barrett’s how often should they have check ups?
No dysplasia evident= every 2/3 years
Low grade dysplasia= every 6 months
High grade dysplasia= intervention
How common is oesophageal adenocarcinoma?
9th most common cancer
Who does adenocarcinoma mainly affect?
The elderly
What is the male/female ratio for adenocarcinoma?
10:1
Describe survival rates for oesophageal cancer
Late presentation, mainly palliative care which is difficult to carry out, high morbidity and complex surgery
What is the 5 year survival for oesophageal cancer?
Less than 20%
How is oesophageal cancer diagnosed?
Endoscopy to get a biopsy
How is staging of oesophgeal cancer carried out?
CT scan and laparoscopy
Describe curative treatment for oesophageal cancer
Neo adjuvant chemo then radical surgery
Describe palliative care for oesophageal cancer
Chemotherpy, DXT, Stent
How is a oesophagectomy carried out?
Two stage Ivor Lewis approach
How common is colorectal cancer?
Most common GI cancer is western world
3rd most common cancer deaths in men and women
What is the lifetime risk of colorectal cancer for men and women
1/10 men
1/14 women
Who does colorectal cancer mainly effect?
Over 50 years old
What are the 4 forms of colorectal cancer? Explain them
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
What are risk factors of colorectal cancer?
Past history
Family history
Diet/ environmental- smoking, obesity etc
Where are colorectal cancers found?
2/3 in descending colon and rectum
1/2 in sigmoid colon and rectum
How do caecal and right sided cancers present?
Iron deficiency anaemia (most common)
Change in bowel habit (diarrhoea)
Late presentations: distal ileum obstruction, palpable mass
How do left sided and sigmoid cancers present?
PR bleeding, mucus Thin stool (late presentation)
How do rectal carcinomas present?
PR bleeding, mucus
Tenesmus
Anal, perianal and sacral pain
What are late presentations of colorectal cancer?
Bowel obstruction
Local invasion: bladder symptoms, female genital tract symptoms
Metastasis: lung=cough, liver= hepatic pain/jaundice, regional lymph nodes
What are signs of primary colorectal cancer?
Abdominal mass
Digital rectal mass
Rigid sigmoidoscopy
Abdominal tenderness and distension (large bowel obstruction)
What are signs of metastasis and complications of colorectal cancer?
Hepatomegaly (mets)
Monophonic wheeze
Bone pain
What are the 3 main investigative tests for colorectal cancer?
Faecal occult blood
Blood test
Double contrast barium enema
Describe a faecal occult blood investigation
Based on pseudoperoxidase activity of haematin
Avoid red meat, horseradish, vit C and NSAIDs 3 days before test
Describe blood tests as an investigation for colorectal cancer
FBC: anaemia, haematinics, low ferritin
Tumor markers: CEA
NOTE- not a diagnostic diagnostic
Describe a double contrast barium enema investigation for colorectal cancer
Doesnt require sedation
More limited in detecting small lesion
All lesions still need to be confirmed by a colonoscopy and biopsy
Describe a colonoscopy as an investigation
Can visualise lesions less than 5 mm
Small polyps can be removed to reduce cancer incidence
Performed under sedation
Describe a CT colonoscopy as an investigation
Can visualise lesions greater than 5 mm
No need for sedation
Less invasive and better tolerated
Colonoscopy needed for diagnosis
Describe an MRI of the pelvis for rectal cancer
Depth of invasion can be identified
No bowel prep or sedation needed
Helps choose between preoperative chemo or straight to surgery
How is colon cancer mainly managed?
By surgery
How is surgery on the right and transverse colon carried out?
Resection and primary anastamosis
How is surgery on the right side carried out?
Hartmann’s procedure (proximal end colonoscopy)
Primary anastomosis (intraoperative bowel lavage and defunctioning ileostomy)
Palliative stent
What is the most common form of pancreatic cancer?
Pancreatic ductal adenocarcinoma
How is does pancreatic cancer often present?
80-85% late presentation
What are survival rates of pancreatic cancer?
Median survival 6 months
5 year survival 0.4- 5%
What age does pancreatic cancer mainly occour
Mostly 60-80%
What are some risk factors for pancreatic cancer?
Chronic pancreatitis T2DM Cholelithasis Diet Cigarette smoking Family history
What are some inherited syndromes accociated with pancreatic cancer risk?
Hereditary pancreatitis Familial atypical multiple mole melanoma Peutz Jeghers syndrome HNPCC FAP
Describe the pathogenesis of pancreatic cancer
Presence of pancreatic intraepithelial neoplasias
PDAs evolve through non invasive precursor lesions, they are microscopic (<5mm) and not visible via imaging
What are clinical presentations of pancreatic cancer?
Jaundice
Weight loss
Pain (70 % at time of diagnosis)
GI bleeding
What part of the pancreas do most pancreatic cancers arise in?
Head of the pancreas
How are carcinomas in the body and tail of the pancreas different to the head?
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
How is the tumor marker CA19-9 relevant in pancreatic cancer?
Falsely elevated in pancreatitis
Conc > 200 confer high specificity
How is ultrasonography useful for pancreatic cancer?
Can identify pancreatic tumors
Can identify dilated bile ducts
Can identify liver metastases
How is dual phase CT useful for pancreatic cancer?
Predicts respectability accurately in 80-90% of cases
Shows continguous invasion
Shows distant metasteses
What imaging types are used for pancreatic cancer?
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
What is EUS and how is it used in pancreatic cancer?
Detects small tumors, assesses vascular invasion
How is laparoscopy used in pancreatic cancer?
Detects metastatic lesions of liver and peritoneal cavity
What is a common feature of most patients with liver cancer?
Most of them have underlying cirrhosis
What is the 5 year survival rate of liver cancer?
Less than 5%
What are resection options for liver cancer?
OLTx
TACE
RFA
How many people with liver cancer can have surgery?
5-15%
What can increase risk of gallbladder cancer?
Gallstones
Porcelain gallbladder
Chronic typhoid infection
What is the 5 year survival rate of gallbladder cancer?
Less than 5 %
How many people with gallbladder cancer can have surgery?
Less than 15%
What can increase risk of cholangiocarcinoma?
Liver fluke
Choledochal cyst
What is the 5 year survival rate of cholangiocarcinoma?
Less than 5%
How many people with cholangiocarcinoma can have surgery?
20-30%
What is the 5 year survival rate of secondary liver metasteses?
0%
What is 5 year survival with optimal surgical resection of primary liver cancer?
Over 30%
What is 5 year survival with optimal surgical resection of gallbladder cancer?
Less than 15%
What is 5 year survival with optimal surgical resection of cholangiocarcinoma?
20-40%
What is 5 year survival with optimal surgical resection of secondary liver metastases?
25-50%
