Lower GI Malignancy

Question 1

List 3 key symptoms associated with Lower GI Malignancy

Answer 1

• Obstruction
• PR bleeding
• Change in Bowel habit

Often need to look at these together

Question 2

What are 2 general signs/ symptoms of bowel Obstruction

Answer 2

• Abdominal pain

- Abdominal distension (Can be due to air/ faeces etc)

Question 3

List 6 non-malignant causes of Bowel Obstruction

Answer 3

• Intussusception (Bowel slides in on itself->narrows)
• Hernias
• Strictures
• Volvulus (Loop of bowel twists around itself + its mesentery)
• Diverticular disease
• Pyloric stenosis

Question 4

Malignant Bowel Obstruction can be in the Small or Large bowel.

How would these differ on presentation?

Answer 4

Small bowel obstruction;
- Nausea/ Vomiting

Large bowel obstruction;
- Constipation (Can be Absolute- no gas passed)

Question 5

List 2 red flags for bowel obstruction

Answer 5

• Weight loss

- Unexplained abdominal pain (Can’t treat/ identify cause etc)

Question 6

List 5 non-malignant causes of PR Bleeding

Answer 6

• Haemorrhoids
• Anal fissure
• Infective gastroenteritis
• IBD
• Diverticular disease

Question 7

Malignant PR Bleeding can either be due to Small or Large Bowel Cancer.

How would small bowel cancer present?

Answer 7

Small bowel cancer;

• Fresh
• Bright red
• Malaena

Question 8

List the red flags for PR bleeding

Answer 8

• Iron deficiency anaemia (40)
• Weight loss (>40)
• Change in bowel habit (>50)
• Tenesmus (Feeling need to defecate after doing so, suggests cancer in Rectum)

Question 9

What are 2 important components to asking about changes in bowel habit?

Suggest 2 associated symptoms to ask about

Answer 9

• Changes in frequency
• Changes in consistency (more watery)
• Bloating
• Abdominal discomfort

Question 10

List 5 non-malignant causes of a change in bowel habit

Answer 10

• Thyroid disorders
• IBD
• Medications
• IBS
• Coeliac Syndrome

Question 11

Suggest 2 red flags for PR bleeding

Answer 11

• Iron deficiency anaemia

- Weight loss

Question 12

Describe Large Bowel cancer (3rd most common cancer in UK)

Answer 12

• Tend to be Adenocarcinomas

- Tend to be due to Polyps changing to Adenoma

Question 13

List 4 risk factors for Large Bowel Cancer

Answer 13

• Family history
• IBD
• Diet + lifestyle
• Polyposis syndromes (FAP, HNPCC)

Question 14

How is large bowel cancer screened for?

Every 2 years in 65-70 year olds

Answer 14

• Faecal Occult samples to test for small amounts of blood

- If +ve, patient referred for colonoscopy

Question 15

Describe FAP including, how Polyps can change to Adenocarcinomas

(Familial Adenomatous Polyposis)

Answer 15

• Autosomal dominant mutation in the TS gene, APC

- Leads to Polyp development on intestinal wall, which grow and become Adenocarcinomas by Dysplasia

Question 16

Compare Right Sided (Ascending) and Left Sided (Descending) Colon Cancer with regards to;

• Weight Loss + Anaemia
• Bowel obstruction
• Tenesmus

Answer 16

Right Sided (Ascending);

• Weight loss + Anaemia
• Bowel obstruction less likely (Bigger lumen, contents more liquid)
• Tenesmus less likely

Left Sided (Descending);

• Weight loss + Anaemia
• Bowel obstruction
• Tenesmus more likely

Question 17

Compare Right Sided (Ascending) and Left Sided (Descending) Colon Cancer with regards to;

• Iliac Fossa mass
• Change in bowel habit
• Disease severity at presentation
• Stenosing or Fungating

Answer 17

Right Sided (Ascending);

• Mass in RIGHT iliac fossa
• Late change in bowel habit
• More advanced at presentation
• ‘Fungating’ (grow outwards like fungi into lumen)

Left Sided (Descending);

• Mass in LEFT iliac fossa
• Early change in bowel habit
• Less advanced at presentation
• ‘Stenosing’ (Grows around periphery causing narrowing ‘Apple core’ sign)

Question 18

Is PR bleeding more likely in Left or Right sided colon cancer?

Compare the Prognosis in Left and Right

Answer 18

Left, has a better Prognosis as it is less advanced at presentation

Question 19

Small bowel cancer is very rare.

List the 5 types

Answer 19

• Stromal
• Lymphoma
• Adenocarcinoma
• Sarcoma
• Carcinoid tumours (Neuroendocrine tumours in GI tract)

Question 20

List 3 symptoms of Small bowel cancer (Can vary widely)

Answer 20

• Weight loss
• Abdominal pain
• Blood in stools

Question 21

List 4 risk factors of small bowel cancer

Answer 21

• IBD
• Coeliac disease
• FAP
• Diet

(Anything that can cause Polyp formation. E.g chronic inflammation)

Question 22

List 3 aspects of General Management of GI Malignancies

Answer 22

Investigation;

• Endoscopy
• Colonoscopy

CT/MRI for Staging;

• TNM
• Dukes (A, B, C, D)

Blood tests;

• FBC
• Tumour markers (CEA= Colorectal carcinoma, CA 19-9= Pancreatic tumour)

Question 23

What are 3 methods of treatment of GI Malignancies

Answer 23

• Chemotherapy
• Radiotherapy
• Surgical Resections