Upper GI Malignancy

Question 1

List 3 key symptoms associated with Upper GI Malignancy

Answer 1

• Epigastric pain
• Jaundice
• Dysphagia

Question 2

What are 3 types of obstruction leading to Dysphagia?

Answer 2

• Extraluminal (compression from outside)
• Intraluminal (in lumen)
• Luminal (in wall)

Question 3

List the Red Flags of Dysphagia

Answer 3

ALARM

• Anaemia
• Loss of Weight
• Anorexia
• Recent onset of progressive symptoms
• Masses/ Malaena

Question 4

List 3 Benign causes of Dysphagia

Answer 4

• Fibrous strictures
• Foreign bodies
• Nervous disorders

Question 5

List 2 Malignant causes of Dysphagia

Answer 5

Oesophageal Carcinoma;

• Squamous cell carcinomas (Strat Squamous epithelia)
• Adenocarcinomas (Columnar epithelia)

Question 6

Which Oesophgeal Carcinoma is more common

Answer 6

• Oesophageal Carcinoma (as mostly Strat squamous)

- Lower 1/3 can develop Adenocarcinoma (Barret’s oesophagus)

Question 7

What are 2 risk factors for Oesophageal carcinoma?

How does it present?

Answer 7

• Smoking
• Barret’s Oesophagus
• Progressive Dysphagia (Solids-> Liquids)
• Spread is common if presenting with symptoms

Question 8

What are 2 methods if investigating for Oesophageal carcinoma?

How good is the prognosis?

Answer 8

• Endoscopy
• Barium swallow

Poor prognosis (5% survival at 5 years)

Question 9

List 4 BENIGN conditions that can cause Epigastric pain

Answer 9

• Oesophagitis
• Gastritis
• Peptic Ulcer Disease PUD
• Pancreatitis

Question 10

What are 2 Red Flags for Epigastric Pain?

Answer 10

• Malaena

- Haematemesis

Question 11

List 3 non-malignant causes of Haematemesis

Answer 11

• Ulcers
• Varices
• ‘Mallory-Weiss Syndrome’ (Repeated vomiting-> Oesophgeal tears)

Question 12

Suggest 1 malignant cause of Haematemesis with Epigastric pain

Answer 12

Gastric Cancer

Question 13

Describe Gastric Cancer in 4 ways

Answer 13

• Typically in Cardia or Antrum (Can cause Dysphagia and outflow obstruction)
• Typically Adenocarcinomas
• 50% have a palpable mass
• Pain similar to Peptic Ulcer (Epigastric)

Question 14

List 6 risk factors of Gastric Cancer

Answer 14

• Age
• More common in Males
• Smoking
• High salt diet
• Family history
• H. pylori (Chronic inflammation anywhere can-> cancer)

Question 15

Describe the Prognosis for Gastric Cancer

Answer 15

• 10% survival after 5 years

- 50% survival after surgery (removing part of stomach + reconstructive surgery

Question 16

Name 2 types of Gastric Cancer other than Adenocarcinomas (most common)

Answer 16

• Gastric Lymphoma

- Gastrointestinal Stromal tumours (GISTs)

Question 17

Describe Gastric Lymphoma

Answer 17

• In MALT tissue
• Presents similarly to Gastric Carcinoma
• Mostly associated with H. pylori
• Prognosis much better than Gastric Carcinoma

Question 18

Describe GISTs

Answer 18

• Sarcomas
• Usually asymptomatic
• Typically Benign, can be Malignant
• Tend to be incidental findings on Endoscopy

Question 19

List the Red Flags for Jaundice

Answer 19

• Hepatomegaly (especially with an irregular border)
• Weight loss
• Ascites
• Painless

Question 20

Describe Primary Malignancy of the Liver

Answer 20

• Very rare
• Hepatocellular Carcinomas
• Typically linked to underlying disease (chronic inflammation)
• Common site for metastases (Any malignant cells in body enter liver)

Question 21

What are 3 routes via which malignancies can metastasise to the liver

Answer 21

• Haematogenous (portal circulation)
• Via lymphatics (common in carcinomas)
• Transcoelomic spread (through body cavities, e.g ovarian, breast lung)

Question 22

What percentage of Pancreatic Cancers are exocrine?

What’s the most common Pancreatic Cancer?

Answer 22

80-90%

Ductal Adenocarcinomas

(Neuroendocrine cancers are rare, and produce insulin)

Question 23

Compare the presentation of Pancreatic Cancers originating in the Head and Body/Tail

Answer 23

Head: Jaundice

Body/ Tail: Symptoms more vague (Malabsorption, Steatorrhea)

Question 24

List 5 risk factors for Pancreatic Cancer

Answer 24

• Family history
• Smoking
• Age (>60)
• More common in males
• Chronic Pancreatitis

Question 25

Describe the Prognosis of Pancreatic Cancer

Answer 25

Extremely poor, survival often measured in months rather than years