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GI and Surgery > Intra-abdominal Cancer > Flashcards

Intra-abdominal Cancer Flashcards

1
Q

Treatment for malignant hypercalcaemia?

A

Fluids and bisphosphonates.

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2
Q

What are the key differentials for painless obstructive jaundice?

A

Pancreatic cancer or cholangiocarcinoma.

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3
Q

New onset of diabetes or worsening of glycaemic control in T2D despite good lifestyle measures and medication can be an indicator of what?

A

Pancreatic cancer

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4
Q

What is migratory thrombophlebitis?

A

Thrombophlebitis - blood vessels come inflamed with an associated thrombus in that area.
Migratory - thrombophlebitis reoccurring in different locations over time.

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5
Q

What type of cancer is pancreatic cancer?

A

Adenocarcinoma

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6
Q

Which is the most common part of pancreas to be affected by cancer?

A

Head

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7
Q

Why does pancreatic cancer cause obstructive jaundice?

A

Tumour of head of pancreas compresses bile duct, obstructing flow of bile from liver.

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8
Q

Name 3 risk factors for pancreatic cancer

A

Age, smoking and alcohol.

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9
Q

What are the main symptoms of pancreatic cancer?

A

Painless jaundice (yellow skin and sclera, pale stools, dark urine and itching), upper abdominal/back pain, weight loss, steatorrhoea, N+V.

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10
Q

What clinical signs would you see on a patient with pancreatic cancer?

A

Palpable epigastric mass, palpable gallbladder, jaundice.

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11
Q

Define Courvoisers law

A

In the presence of jaundice and a palpable gallbladder, gallstones is unlikely, it is suggestive of pancreatic cancer or cholangiocarcinoma.

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12
Q

What is Trousseau’s sign?

A

Migratory thrombophlebitis - sign of pancreatic cancer .

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13
Q

What are the referral guidelines for suspected pancreatic cancer?

A

New onset jaundice in > 40 - 2 week wait referral.
Weight loss + additional symptom in > 60 (diarrhoea, back pain, abdominal pain, nausea, vomiting, constipation, new onset diabetes) - CT abdomen.

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14
Q

What is the tumour marker for pancreatic cancer?

A

CA 19-9

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15
Q

What investigations would you do for pancreatic cancer?

A

Bloods: FBC, U&Es, LFTs, clotting screen, bone profile.
CA 19-9.
CT chest, abdomen, pelvis.
MRCP.
ERCP - stent & biopsy.

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16
Q

What type of surgeries can you do for pancreatic cancer?

A

Total pancreatectomy.
Distal pancreatectomy.
PPPD (modified Whipple).
Whipple procedure.

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17
Q

What is a Whipple procedure?

A

Removal of head of pancreas, pylorus of stomach, duodenum, gallbladder, bile duct and relevant lymph nodes. AKA pancreaticoduodenectomy.

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18
Q

What palliative treatments are there for pancreatic cancer?

A

Stents to relieve obstruction.
Surgery to bypass obstruction.
Chemotherapy.
Radiotherapy.

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19
Q

What is the intervention of choice in patients with malignant distal obstructive jaundice due to unresectable pancreatic cancer?

A

Biliary stenting.

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20
Q

What is the main risk factor for cholangiocarcinoma?

A

Primary sclerosing cholangitis.

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21
Q

What is the tumour marker for cholangiocarcinoma?

A

CA 19-9

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22
Q

Describe the clinical features of cholangiocarcinoma

A

Persistent biliary colic, anorexia, weight loss, jaundice, palpable mass in RUQ (Courvoisier sign), Sister Mary Joseph nodes, Virchow node.

23
Q

Gastrectomy may result in what vitamin deficiency?

A

Vitamin B12

24
Q

How might bowel cancer be identified?

A

Screening, incidentally on imaging or endoscopy, presentation of change in bowel habit, iron deficiency anaemia or bowel obstruction.

25
Q

Where is colorectal cancer ranked in the UK for being the most common?

A

4th most common cancer.

26
Q

What is the peak incidence of colorectal cancer?

A

85-89 years old.

27
Q

List the risk factors associated with colorectal cancer

A

FHx, FAP, HNPCC, IBD, increasing age, diet high in processed/red meat, diet low in fibre, obesity, smoking, alcohol.

28
Q

What does FAP stand for and what mutation is it?

A

Familial adenomatous polyposis.
Mutation in APC tumour suppressor gene forming polyps (adenomas) in large bowel.

29
Q

What does HNPCC stand for and what mutation is it?

A

Hereditary nonpolyposis colorectal cancer.
Mutation in DNA mismatch repair genes, causing tumours (adenocarcinomas) to develop in isolation (no polyps).

30
Q

What is the other name for HNPCC?

A

Lynch syndrome

31
Q

What other cancer is HNPCC associated with?

A

Endometrial

32
Q

Is sporadic or inherited form of colorectal cancer more common?

A

Sporadic

33
Q

Mutations in which genes cause hyperproliferation of epithelium forming polys (adenomas), which eventually change into adenocarcinomas?

A

APC (tumour suppressor), p53 (tumour suppressor), KRAS (proto-oncogene).

34
Q

Is left or right sided colorectal cancer more common?

A

Left sided - rectum and sigmoid colon.

35
Q

What is the comet common site of metastatic spread in colorectal cancer?

A

Liver

36
Q

Describe the clinical features of colorectal cancer

A

Change in bowel habit (diarrhoea/constipation).
Weight loss.
Rectal bleeding.
Abdominal pain.
Fatigue.
Reduced appetite.
Iron deficiency anaemia.
Abdominal/rectal mass.

37
Q

How does right sided vs left sided colorectal cancer typically present?

A

Right: iron deficiency anaemia.
Left: change in bowel habit or bowel obstruction.

38
Q

What is the criteria for a 2 week wait referral for suspected colorectal cancer?

A

> 40 with abdominal pain + weight loss.
50 with unexplained rectal bleeding.
60 with change in bowel habit or iron deficiency anaemia.

39
Q

What is a FIT test?

A

Faecal immunochemical test (FIT), checks for human haemoglobin in stool.

40
Q

When should a FIT test be used in GP?

A

> 50 with unexplained weight loss.
< 60 with change in bowel habit.

41
Q

Describe the bowel cancer screening program in England

A

Everyone aged 60-74 years screened every 2 years with home FIT test.
Slowly expanding to 50-59 years.
Positive FIT test —> colonoscopy referral.

42
Q

What is the gold standard test for colorectal cancer?

A

Colonoscopy

43
Q

What test can be used in patients unfit for a colonoscopy?

A

CT colonography

44
Q

What is the tumour marker for bowel cancer?

A

CEA - used to measure risk of recurrence (not screening).

45
Q

What is a right hemicolectomy?

A

Removal of caecum, ascending and proximal transverse colon.

46
Q

What is a left hemicolectomy?

A

Removal of distal transverse and descending colon.

47
Q

What is a high anterior resection?

A

Removal of sigmoid colon.

48
Q

What is a low anterior resection?

A

Removal of sigmoid colon and upper rectum.

49
Q

What is an abdomino-perineal resection (APR)?

A

Removal of rectum and anus (+/- sigmoid colon) and suturing over anus. Permanent colostomy.

50
Q

What is Hartmann’s procedure?

A

Removal of rectosigmoid colon and suturing over rectal stump. Creation of temporary or pernamnet colostomy.

51
Q

Describe the management of colorectal cancer

A

Surgery with neoadjuvant/adjuvant chemotherapy and radiotherapy.

52
Q

What tests would you do to follow up a patient after curative bowel cancer surgery?

A

CEA and CT thorax/abdomen/pelvis.

53
Q

Describe the guidelines for urgent 2 week wait referral for suspected pancreatic cancer

A

Patients aged >= 40 years with jaundice.
Patents aged >=60 years with weight loss plus: diarrhoea, back pain, abdominal pain, nausea, vomiting, constipation or new-onset diabetes.

GI and Surgery (14 decks)

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