GI tract > GI malignancy > Flashcards

GI malignancy Flashcards

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1
Q

What are common sites of cancer in the GI system?

A
  • Oesophagus
  • Liver
  • Stomach
  • Pancreas
  • Gallbladder
  • Large intestine
  • Anus
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2
Q

What is the difference between carcinoma and adenocarcinoma?

A
  • Carcinoma is malignancy of cells that make up epithelial lining of skin or tissue lining organs
  • Adenocarcinoma is malignancy of glandular cells in epithelial tissue
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3
Q

What is an adenoma?

A
  • Benign tumour formed from glandular structures in epithelial tissues
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4
Q

What presentation is suggestive of oesophageal cancer?

A
  • Severe dysphagia to solids
  • Worsening dysphagia to liquids
  • Unexplained weight loss
  • Mild odynophagia
  • Coughing up mucus secretions
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5
Q

What is the histology of oesophageal cancer?

A
  • Most common squamous cell carcinoma worldwide
  • Generally affects upper 2/3
  • Adenocarcinomas from columnar epithelium can occur in lower 1/3
  • Barrett’s oesophagus
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6
Q

What are the red flags for oesophageal cancer?

A
  • Progressive dysphagia
  • Anaemia
  • Unintentional weight loss
  • Anorexia
  • Recent onset of progressive symptoms
  • Malaena or masses
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7
Q

What are the risk factors for oesophageal cancer?

A
  1. Squamous cell carcinoma
    - smoking
    - alcohol use
    - dietary intake e.g. hot beverages
  2. Adenocarcinomas
    - obesity
    - reflux disease
    - Barrett’s oesophagus
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8
Q

What is the prognosis of oesophageal cancer?

A
  • 5% survival at 5 years
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9
Q

What are the investigations for oesophageal cancer?

A
  • FBC to check for anaemia
  • Oesophagogastroduodenoscopy (OGD) with biopsy - helps to determine whether benign or cancerous
  • CT thorax and abdomen - size of primary, local invasion, metastatic spread
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10
Q

What is the treatment for oesophageal cancer?

A
  • Endoscopic therapies (limited disease)
  • Oesphagectomy (removes oesophagus)
  • Chemoradiotherapy
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11
Q

What is the histology of gastric cancer?

A
  • Most commonly adenocarcinomas
  • Most often found in gastric cardia
  • Can get lymphoma, leiomyosarcoma, neuroendocrine tumours
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12
Q

How is gastric cancer classified?

A
  • Location - either cardia gastric cancer or non-cardia gastric cancer
  • Lauren classification tells us the type
  • Either diffuse or intestinal
  • Diffuse occurs more often in young people and has worse prognosis
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13
Q

What are the general risk factors for gastric cancer?

A
  • Age 50-70
  • Male
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14
Q

What are the strong risk factors for gastric cancer?

A
  • Pernicious anaemia
  • H-Pylori
  • N-nitroso compounds
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15
Q

What are the weak risk factors for gastric cancer?

A
  • Family history
  • High salt (weakens gastric mucosa and enhances negative effects of N-nitroso compounds)
  • Smoking
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16
Q

What is the common clinical presentation of gastric cancer?

A
  • Unexplained weight loss
  • Epigastric abdominal pain
  • Lymphadenopathy - Virchow’s node (left supraclavicular fossa)
  • Dysphagia (if cancer is located around the cardia)
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17
Q

What is the prognosis of gastric cancer?

A
  • 70% 5-year survival for local disease
  • Decreases to 5% if there’s metastasis
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18
Q

What are the investigations for gastric cancer?

A
  • Bloods - look for iron deficiency anaemia
  • Upper GI endoscopy and biopsy for tissue diagnosis
  • CT CAP (chest, abdomen and pelvis) for staging/determining extent of disease
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19
Q

How is gastric cancer managed?

A
  • Endoscopic mucosal resection - treats superficial cancer
    -Surgery to remove all or part of the stomach (gastrectomy) - treats localised cancer
  • If pt not suitable for surgery, then chemoradiation
  • Chemotherapy/immunotherapy and supportive care - treats advanced/metastatic cancer
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20
Q

What is the histology of pancreatic cancer?

A
  • Pancreatic ductal adenocarcinoma is main type
  • Pancreatic neuroendocrine tumours are rare and originate from pancreatic endocrine cells
  • Cancers may be non-functional or may secrete hormones
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21
Q

What are the risk factors for pancreatic cancer?

A
  • Smoking
  • Chronic pancreatitis
  • Inherited mutations
  • Men > women
  • Increasing age
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22
Q

Which mutations can lead to pancreatic cancer?

A
  • BRCA1
  • BRCA2
  • PALB2
  • Familial syndromes
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23
Q

What is the clinical presentation of pancreatic cancer?

Study These Flashcards
A
  • Painless jaundice
  • Unexplained weight loss
  • Abdominal/back pain
  • New-onset type 2 diabetes mellitus in an adult over 50 without any obesity-related risk factors
24
Q

What are the symptoms of pancreatic cancer?

Study These Flashcards
A
  • Indigestion
  • Tummy pain or back pain
  • Changes to your poo
  • Unexplained weight loss/loss of appetite
  • Jaundice
25
What are the investigations for pancreatic cancer?
- Bloods - LFTs if jaundiced, CA 19-9 (tumour marker) - CT - focused on pancreas can give very high diagnostic accuracy and can assess resectability in 80-90% - Ultrasound scan - can detect cancer arising in head of pancreas with reasonable accuracy but not in body or tail
26
What is the management for pancreatic cancer?
- 10-15% are suitable for surgical resections (followed by pancreatic enzyme replacement) - Only possible cure - 20% 5 year survival - Biliary stenting to relieve jaundice - Chemotherapy and symptom management (if not resectable)
27
What is the histology of hepatocellular carcinoma?
- Hepatocellular carcinoma - Primary cancer arising from hepatocytes (usually with a background of cirrhosis)
28
What are the risk factors for hepatocellular carcinoma?
- Occur in patients with underlying cirrhosis - Many causes of cirrhosis including alcohol, Hep B&C
29
What is the clinical presentation of hepatocellular carcinoma?
- Symptoms of underlying liver disease can often mask malignancy e.g. ascites, fatigue - Acute hepatic decompensation or RUQ pain can be signs of development of HCC
30
What is the prognosis of hepatocellular carcinoma?
- 5 year survival rate ~50% with complete surgical resection or liver transplantation - In advanced HCC = median overall survival time with treatment is approx 1 year
31
What are the investigations for hepatocellular carcinoma?
- Blood tests for LFTs, prothrombin time/INR (checks synthetic function), viral hepatitis panel - USS - non invasive and good for screening high risk pts - CT/MRI of abdomen - Liver biopsy
32
What is the treatment for hepatocellular carcinoma?
- If suitable then ablation, resection or transplantation - If not suitable for any of the above then chemotherapy/immunotherapy to slow tumour growth
33
Outline liver metastases
- Liver is a common site for metastases from many cancer types - Can be haematological e.g. portal spread from other GI viscera - Or lymphatic spread - Or spread via other routes e.g. ovarian is via transcoelomic spread
34
What is the histology for cholangiocarcinoma (bile duct cancers)?
- Majority are adenocarcinomas - Can be intra- or extrahepatic
35
What are the risk factors for cholangiocarcinoma?
- Liver and bile duct diseases - cirrhosis, alcoholic liver disease, non-specific bile duct diseases, gallstones, primary sclerosing cholangitis - Infections - High alcohol consumption - Exposure to certain toxins/medications
36
What is the clinical presentation of cholangiocarcinoma?
- Painless jaundice - Pruritis - Dark urine - Light colour stool (absence of stercobilin due to biliary obstruction)
37
What is the prognosis of cholangiocarcinoma?
- Generally poor - 5 year overall survival rate in patients with metastatic disease is 2%
38
What is the histology of colorectal cancer?
- Adenocarcinomas which progress from normal epithelium in a classical pattern
39
What are the risk factors of colorectal cancer?
- High dietary fat - High red meat consumption - Low dietary fibre - Alcohol intake - History of IBD - Genetic conditions such as FAP and HNPCC
40
What is the clinical presentation of colorectal cancer?
- Blood in stool - Altered bowel habits - Bowel obstruction - Perforation - Symptoms due to hepatic or peritoneal metastases e.g. abdo pain or ascites
41
What is the prognosis of colorectal cancer?
- Best overall prognosis - 5-year survival rate ranges from 50% - 95% (non-metastatic)
42
What are the red flags of colorectal cancer?
- Blood in the stool/rectal bleeding (either fresh red vs mixed in stool vs malaena) - Change in bowel habit - Iron deficiency anaemia - Unexplained weight loss - Tenesmus - Mass on rectal examination
43
How may bowel habits change due to colorectal cancer?
- Inquire more about pain when opening bowels (makes it more likely to be haemorrhoids or fissures) - If black and tarry stool - more likely to be upper GI - As we get older, a change in bowel habit is more likely to be due to malignancy - Can present with constipation as cancer can obstruct bowels - Can lead to overflow diarrhoea
44
Outline the features of right-sided colorectal cancer
- Weight loss - Occult bleeding (not visible to naked eye) - Less likely to present with bowel obstruction - Mass in right iliac fossa -More advanced disease at presentation - Late change in bowel habits - Fungating (ulceration)
45
Outline the features of left-sided colorectal cancer
- Weight loss - Rectal bleeding (bright red and fresh) - Bowel obstruction more likely - Mass in left iliac fossa - Less advanced disease at presentation - Early change in bowel habit - Stenosing (strictures/narrowing)
46
What is the adenocarcinoma sequence?
- Series of genetic and epi-genetic mutations - Activation of oncogenes - Inactivation of tumour suppressor genes - Normal glandular epithelial cells become adenomas - Adenomas become invasive carcinomas
47
What are the investigations for colorectal cancer?
- Stool tests e.g. FIT - Blood tests - FBC for anaemia, CEA - Colonoscopy and biopsy - Imaging - CT and MRI
48
How is colorectal cancer managed?
- Largely dependent on stage - Surgery with pre or post-operative chemotherapy/ immunotherapy - Chemotherapy/immunotherapy if not for surgical intervention
49
What are the barriers to participating in bowel screening?
- Fear and denial around test outcome - Individual perceived low risk/doesn't want to know result - Being male - Pt believes that test is not applicable to them - Ethnic minorities - Lower socio-economic group -
50
What are the barriers to participating in bowel screening?
- Fear and denial around test outcome - Being male - Pt believes that test is not applicable to them - Ethnic minorities - Lower socio-economic group
51
What is the histology of anal cancer?
- Squamous cell carcinomas
52
What are the risk factors for anal cancer?
- Strongly associated with HPV infection - HIV infection - Engaging in anal-receptive sexual intercourse - Chronic local inflammation due to IBD and recurrent anal fissures
53
What is the clinical presentation of anal cancer?
- Perianal pruritis or pain - Bleeding - Discharge - Mass-like sensation
54
What is the prognosis of anal cancer?
- More than 70% of cases can be cured with chemoradiation
55
How do we lower the incidence of anal cancer?
- Pap smears in high-risk populations - Treatment of HIV infection
56
How is GI cancer staged (TNM staging)?
- TNM staging is standardised system - T = size of primary tumour - N = extent of regional lymph node involvement - M = metastatic spread - Typically then converted to an overall stage 1, 2, 3 or 4
57
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