S3: Gastrointestinal > 8a.) GI Malignancy > Flashcards

8a.) GI Malignancy Flashcards

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1
Q

There are numerous types of GI cancers; order the following starting with most common

A
  • Bowel
  • Pancreas
  • Oesophagus
  • Stomach
  • Liver
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2
Q

State 3 symptoms that would indicate an upper GI malignancy and 3 symptoms that would indicate a lower GI malignancy

A
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3
Q

How common is GI cancers compared to other cancers?

A
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4
Q

State the 2 main forms of oesophageal cancer

A
  • Squamous cell carcinoma
  • Adenocarcinoma (most adenocarcinomas are related to Barrett’s oesophagus)
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5
Q

Most adenocarcinomas are related to…?

A

Barrett’s oesophagus

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6
Q

What is a common presentation for oesophageal cancer?

A

Dysphagia

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7
Q

State 5 red flags associated with dysphagia

A
  • Anaemia
  • Loss of weight (unitentional)
  • Anorexia
  • Recent onset of progressive symptoms
  • Masses/Malaena
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8
Q

There are two types of oesophageal carcinoma; describe what the type of carcinoma is linked to

A

Type of carcinoma is linked to epithelial type:

  • Stratified squamous: squamous cell carcinoma
  • Columnar epithelium: adenocarcinoma
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9
Q

Describe, where in the oesophagus (e.g. proximal or distal), you are most likely to find the following:

  • Squamous cell carcinoma
  • Adenocarcinoma
A
  • Squamous cell carcinoma: most of oesophagus
  • Adenocarcinoma: lower part

NOTE: epithelium changes just above lower oesophageal sphincter

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10
Q

What is the prognosis for oesophageal carcinomas?

A

Poor- 5% survival at 5 years

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11
Q

Which type of carcinoma is more common in oesophagus and why?

A

Squamous cell carcinoma because the carcinoma type is related to the epithlial type and most of oesophagus is stratified squamous epithelium

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12
Q

Describe the typical presentation of someone with oesophageal carcinoma

A
  • Progressive dysphagia
  • Other red flags

See example:

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13
Q

Describe Barrett’s oesophagus, include:

  • What it is
  • What it is often caused by
  • It is symptomatic?
  • Is it cancerous?
  • Can it increase risk of oesophageal cancer?
A
  • Metaplasia of epithelium in distal oesophagus; changes from stratified squamous to columnar epithelium
  • GORD
  • Asymptomatic
  • Not a cancer itself
  • It can lead to dysplasia and is therefore a risk factor for cancer
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14
Q

Remind yourself of the quadrants of the abdomen and try and suggest one condition that could cause pain in that area

A
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15
Q

State some red flags associated with epigastric pain

A
  • Malaena
  • Haematemesis
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16
Q

Where in the stomach is gastric cancer typically found?

A
  • Cardia
  • Antrum
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17
Q

Describe the typical presentation of someone with gastric cancer

A
  • Epigastric pain
  • 50% palpable mass
  • Malaena
  • Haematemesis
  • Risk factors: smoking, hight salt diet, family history, Helicobacter pylori, chronic inflammation
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18
Q

State some risk factors for gastric cancer

A
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19
Q

Discuss the prognosis of gastric cancer

A

lPrognosis generally poor:

  • 10% 5 year survival
  • 50% after curative surgery
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20
Q

Where in GI tract is the most common site for a primary gastrointestinal lymphona?

A

Stomach

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21
Q

Stomach ulcers are potentially malignant; true or false?

A

True

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22
Q

What is the most important environmental factor in stomach cancer?

A

Helicobacter pylori

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23
Q

The majority of stomach cancers are what kind of carcinomas?

Majority of stomach carcinomas arsie from what 2 things?

A

Adenocarcinomas that commonly arise from:

  • Chronic gastritis
  • Metplasia
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24
Q

Other than adenocarcinomas, state two other cancers that can occur in the stomach

A
  • Gastric lymphoma
    • MALT tissue
    • Similar presentation to gastric adenocarcinoma
    • Highly associated with helicobacter pylori
    • Prognosis much better than gastric cancer
  • Gastrointestinal stromal tumours (GISTs)
    • Sarcomas (not epilthelial)
    • Tend to be an incidental finding on endoscopy
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25
Suggest a reason why the prognosis for stomach cancers is often poor
Stomach cancers often present late and are therefore advanced once they are diagnosed/detected
26
Who does pancreatic cancer generally affect? State 2 risk factors for pancreatic cancer
* Generally affects **over 60's** *(with no specific cause identified)* * Risk factors: * **Chronic pancreatits** * **Smoking**
27
State 4 red flags associated with jaundice
* Hepatomegaly * Irregular border * Unintentional weight loss * Painless * Ascites
28
Primary malignancy of the liver (hepatocellular carcinoma) is very common; true or false
FALSE- primary malignancy of the liver is very **rare**
29
Suggest why the liver is a common site for metastases
Portal system drains entire GI tract (and also drains left testicle and ovary) hence increased probability of malignant cells going through the liver
30
Describe 3 mechanisms by which malignancies can metastasise to liver
* **Haematogenous: via portal system** * **Lymphatics:** * Common in carcinomas * Check the sentinal lymph node * **Spread from other systems:** * Ovarian: transcoelomic (through peritoneal cavity) * Breast * Lung
31
Describe how cancer in the head of the pancreas in comparison to the tail of the pancreas may present differently
* Cancer in pancreas head: jaundice *(post hepatic obstruction?)* * Cancner in body/tail: more vague symptoms which often relate to function of the pancreas e.g. steatorrhea because lack of lipase production leading to fatty stools
32
What is the most common form of pancreatic cancer and where is it found?
Dutal adenocarcinomas are most common and pancreatic head is most commonly affected portion of pancreas
33
Explain why cancer of head of pancreas can cause jaundice?
Can interfere with biliary flow into duodenum leading to post-hepatic obstructive jaundice
34
State somer risk factors for pancreatic cancer
* Family history * Men * Age (\>60yrs) * Chronic pancreatitis
35
State some sypmtoms of pancreatic cancer
36
State the prognosis for pancreatic cancer?
Poor
37
What are the 3 key symptoms that could indicate lower GI malignancy?
* Obstruction * PR bleeding * Change in bowel habit
38
State 2 symptoms that often accompany bowel obstruction
* Abdominal distension * Abdominal pain
39
State some benign and some malignant differential diagnoses for bowel obstruction
_Benign_ * Volvulus: torsion of a loop of intestine * Diverticular disease * Hernias * Strictures * Intussusception: part of intestine slides into adjacent part of intestine/one semgent folds into another * Pyloric stenosis _Malignant_ * Small bowel * Large bowel
40
How could you differentiate between a small and a large bowel obstruction bases on symptoms?
* Small bowel: nausea/vomitting * Large bowel: absolute constipation (can't pass gas or faeces)
41
Is the small intestine a common site for adenomas and carcinomas? Is this surprising?
Uncommon site for adenomas and carcinomas; this is suprising considering its large surface area and rapid cell turnover
42
State some benign and some malignant differential diagnoses for PR bleeding
_Benign_ * Haemorrhoids * Anal fissures * Infective gastroenteritis * IBD * Diverticular disease _Malignant_ * Small vs large bowel cancer
43
When someone has PR bleeding we have to establish the nature of the bleeding; what do we mean by this?
* Fresh blood- bright red * Older blood/from upper GI- malaena * Any associated symptoms
44
State some red flags associated with PR bleeding
* Age dependent * Fe deficient anaemia * Unexplained weight loss * Change in bowel habit * Tenesmus (cramping pain in rectal area that makes you feel like you need a poo when you have just had one- feeling like you need to go to toilet. Because of growth in rectum)
45
State 2 red flags associated with obstruction of small or large bowel
* Unintentional weight loss * Unexplained abdominal pain
46
If someone states they have had a change in their bowel habits, what further information do we need to find out?
* Change in frequency * Change in consistecy * Associated symptoms
47
A patient comes to you stating they have had a change in their bowel habits. Your differential diagnoses will vary dependent on what the change in bowel habit is. State some benign differential diagnoses of change in bowel habit
* Thyroid disorder * IBD * Medication related * IBS * Coeliac
48
State some red flag associated with a change in bowel habits
* Age dependent * Fe deficient anaemia * Unexplained weight loss * PR blood loss
49
What is the most common colorectal cancer?
Adenocarcinoma
50
State some risk factors for colorectal cancer
* Family history * IBD * Polyposis syndromes e.g. FAP, HNPCC ( * Diet & lifestyle
51
What is familial adenomatous polyposis
Inherited condition where many adenomatous polyps develop and these adenomatous polps invariably undergo malignant change causing colorectal cancer
52
Describe how adenomatous polyps develop into adenocarcinomas
* Proliferation of polyp * Dysplasia occurs
53
Colorectal cancers are related to a number of genetic events such as... ?(3) *HINT: think back to path pro neoplasia*
* Activation of oncogenes * Loss of tumour supressor genes * Ineffective DNA repair
54
What % of colorectal cancers are adenocarcinomas?
100% All colorectal cancers are adenocarcinomas
55
What % of colorectal cancers occur in rectum and what % occur in sigmoid colon?
* 50% rectum * 30% sigmoid colon
56
Most colorectal cancers can be viewed with a...?
Sigmoidoscope (as 50% occur in rectum, 30% occur in sigmoid colon)
57
Describe some symptoms that would make you think the colorectal cancer is in the rectum as oppose to the colon
Symptoms suggest of rectal cancer: * PR bleeding *(as rectal cancers usually ulcerating)* * Tenesmus *(due to distension of rectum)*
58
Compare and contrast symptoms for right sided colon cancer and left sided colon cancer
* Right sided: often present later and more advanced as the caecum and colon are more distensible * Left sided: often get obstructive symptoms as the left sided colon cancers are usually stenosing AND contents are more solid in left side
59
Small bowel cancer is common; true or false
FALSE- small bowel cancer is rare
60
State the 5 different types of small bowel cancer
* Stromal * Lymphoma * Adenocarcinoma * Sarcoma * Carcinoid tumours
61
State some risk factors for small bowel cancer
* IBD * Coeliac disease * FAP (familial adenomatous polyposis) * Diet
62
State some symptoms of small bowel cancer
* Weight loss * Abdominal pain * Blood in stools
63
Recap TNM staging
Most common method of staging extent of a tumour; standardised across world for various cancers but each cancer has own specific TNM criteria: * T: size of primary tumour (T1-T4) * N: extension of regional node metastases via lymphatics (N0-N3) * M: extent of distant metastatic spread via blood (M0 or M1)
64
Recap Duke's staging
Duke's staging used for colorectal carcinoma (but TNM is preferred world wide) * A: invasion into but not through bowel wall * B: invasion through bowel wall * C: involvement of lymph nodes * D: distant metastases
65
Describe the general management of cancers
* Staging * Blood test- FBC, tumour markers (CEA, CA 19-9) * CT/MRI * Endoscopy/colonoscopy/capsule endoscopy * Treatment: * Chemotherapy * Radiotherapy * Surgical resections
66
Dysphagia can be caused by extraluminal, luminal or intraluminal causes; describe each and give an example
* Extraluminal: something outside GI tract compressing oesophagus e.g. tumour of lungs * Luminal: something wrong with tube itself e.g. stenosis * Intraluminal: something stuck in lumen e.g. foreign object
67
State 2 risk factors for oesophageal carcinoma
* Smoking * Barett's oesophagus
68
State 4 common causes of upper GI bleeding
Ones in green
69
Chronic inflammation increases risk of malignancy; true or false
True
70
State some malignancies that commonly metastasise to liver
* Lung cancer * Breast cancer * Renal cancer * Prostrate cancer
71
Is there any screening for large bowel cancer?
YES- very sucessful: * Faecal occult blood samples
72
Which, out of left sided colon cancer and right sided colon cancer, is often detected earlier?
Left sided colon cancers detected earlier than right sided colon cancers generally
73
What is this sign called?
Apple core sign
74
State2 tumour markers and which cancers they are indicative of
CEA- bowel cancer CA 19-9- pancreatic cancer
S3: Gastrointestinal
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