Wk 16: GI cancers in practice Flashcards
What are the different types of GI cancers?
Upper GI:
- Oesophageal
- Stomach
- Pancreas
Lower GI:
- Colorectal
Where can gastric cancer start?
- Gastric mucosa (adenocarcinoma)
- Connective tissue of gastric wall (GIST)
- Neuroendocrine tissue (carcinoid)
- Lymphoid tissue
What percentage of gastric cancer is preventable + what are the factors that are preventable?
54%
- H pylori
- Smoking
- Alcohol
- Obesity
- Diet
What is H pylori?
- Bacteria in mucus lining of stomach
- Causes: inflammation, stomach ulcers + cancer
- Diagnose: blood, breath + stool
- Treatment: 7 day triple: 2 Abx + PPI BD
What are the alarm symptoms of gastric cancer?
- Dysphagia
- Unintentional weight loss
- Epigastric mass
- Recent dyspepsia >55yrs
- Persistent vom
- Iron deficiency anaemia
What are the types of surgery available for gastric cancer?
- Endoscopic mucosal resection - early stage
- Total/subtotal gastrectomy
What are the chemo/radiotherapy available for gastric cancer?
Chemo:
- Neoadjuvant/adjuvant
- Palliative: red symptoms
- EOX, EOF, FLOT
Radio:
- Not for early stage
- Palliative: shrink if obs - red gastric bleed
Where can oesophageal cancer start?
- Squamous cells
- Grandular cells (adenocarcinoma)
What percentage of oesophageal cancer is preventable + what are the factors that are preventable?
59%
- Smoking
- Alcohol
- Obesity
- Gord
What are the symptoms of oesophageal cancer?
- Dysphagia
- Heartburn
- Indigestion
- Nausea
What are the surgical management available to esophageal cancer?
Surgery:
- Oesophagectomy (partial/full)
Stenting: symptom control
When do you use chemoradiotherapy in esophageal cancer?
- Inoperable local disease
- Unift for surgery
- Early stage
- Before surgery
When do you use palliative chemotherapy or radiotherapy in oesophageal cancer?
- Chemo: metastatic/locally advanced
- Radio (external beam/brachytherapy): red dysphagia + chest pain
What is the targeted treatment for oesophageal cancer?
Herceptin in HER2 +ve cancer
What percent of pancreatic cancer is preventable + what are the factors that are preventable?
31%
- Smoking
- Obesity
- Alcohol
What are the symptoms of pancreatic cancer?
- Pain in back/stomach
- Weightloss
- Jaundice
What are the surgical management available to pancreatic cancer?
Pancreatectomy:
- Whipple: removes head of pancreas, duodenum + gallbladder
- Distal: removes bod + tail
- Total: removes pancreas
When do you offer chemoradiotherapy in pancreatic cancer?
- Borderline resectable: shrink tumour before surgery
- Locally advanced cancer
What are the symptoms of colorectal cancer?
- Anorexia
- Anaemia
- Passing mucus
- Di then constipation
- Blood in stool
- Rectal bled
- Palpable mass
What age do you not normally see GI cancer?
<55yrs old
What is the treatment for colorectal cancer?
Combination of surgery, radio + chemo (surgery = initial)
Can you reverse a stoma?
Yes depending on position + quantity of bowel removed
What is DPD?
Dihydropyrimidine dehydrogenase:
- Enzyme that process thymine + uracil
- Breakdown fluorouracil + capecitabine
What happens if a patient is DPD deficient?
Severe side effects as chemo drugs build up:
- Neutropenia, anaemia, thrombocytopenia
- Di
- N+V
- Mucositis
What is the surgery used for metastatic disease?
- Palliative
- Resection liver/lung metastases
- Resection for single metastases
What is the chemo for metastatic disease?
- 1st line: Xelox/Folox
- 1st line metastatic colorectal: Folox/Folfiri + cetuximab
- Combined w/ raltitrexed
