GI Cancers Flashcards
Define cancer
CANCER = • A term for diseases in which abnormal cells divide without control and can invade nearby tissues.
What are the two types of neuroendocrine cancers of GI tract?
neuroendocrine tumours (NETs) and gastrointestinal stromal tumours (GISTs)
What is the most common GI cancer in western society?
Colorectal cancer
Colorectal cancer usually affects people above what age?
50
Outline the Wilson and Jungner criteria (7)
1.The condition sought should be an important health problem2. There should be an accepted treatment for patients with recognised disease3. Facilities for diagnosis and treatment should be available4. There should be a recognisable latent or early symptomatic stage5. There should be a suitable test or examination6. The test should be acceptable to the population7. The natural history of the condition, including development from latent to declared disease, should be adequately understood
What are the three forms of colorectal cancer?
Sporadic, familial and hereditary syndrome
What are the two types of epithelial cell GI cancer?
Squamous cell carcinoma
Adenocarcinoma
what are the two types of neuroendocrine GI cancer?
Neuroendocrine tumours (NETs) and Gastrointestinal stromal tumours
What are the three connective tissue GI cancer?
Leiomyoma, leiomyosarcomas, liposarcomas
What are the characteristics of sporadic colorectal cancer?
Absence of family history, older population, isolated lesion
What are the characteristics of familial colorectal cancer?
Family history, higher risk if index case is young (<50years) and the relative is close
What are the characteristics of hereditary syndrome colorectal cancer?
Family history, younger age of onset, specific gene defects
•e.g. Familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal cancer (HNPCC or Lynch syndrome)
What is the histopathology of colorectal cancer?
Adenocarcinoma
Outline the pathophysiology of colorectal cancer:
normal epithelium + (aspirin and other NSAIDS, folate, calcium) + APC mutation ->
hyper proliferation epithelium with aberrant cryptic foci, small adenoma, large adenoma, colon carcinoma
Outline the risk factors of colorectal cancers
Past history
•Colorectal cancer
•Adenoma, ulcerative colitis, radiotherapy
•Family history
•1st degree relative < 55 yrs
•Relatives with identified genetic predisposition
•(e.g. FAP, HNPCC, Peutz-Jegher’s syndrome)
•Diet/Environmental
•?carcinogenic foods
•Smoking
•Obesity
•Socioeconomic status
What is the clinical presentation of colorectal cancer dependent on?
Location
What percentage of colon cancer are in the descending colon and rectum vs. In the sigmoid colon and rectum?
2/3 descending colon and rectum
1/3 sigmoid colon and rectum
What does the term mural indicate?
Can be across any layer of the oesophagus
What are the characteristics of caecel and right sided cancer?
iron deficiency anaemia, change of bowel habits, distal ileum obstruction, palpable mass (last 2 r late stage)
What are the characteristics of left sided and sigmoid cancer?
PR bleeding, mucus and thin stool (late)
What are the characteristics of rectal carcinoma?
PR bleeding, mucus, tenesmus, anal/perineal/sacral pain (late)
What are the metastases of colorectal cancer usually?
Liver, lung, regional lymph nodes, peritioneum
What is the name of the nodule seen in the metastases of colorectal cancer to the peritoneum?
Sister Marie Joseph nodule
What are the signs of primary colorectal cancer?
abdominal mass, DRE > 12cm dentate and reached by examining finger, rigid sigmoidoscopy, abdominal tenderness and distension – large bowel obstruction
What are the signs of metastases and complications of colorectal cancer?
Hepatomegaly, monophonic wheeze, bone pain
What investigations are made in suspected colorectal cancer?
Faecel occult blood - henoccult or FIT, full blood test - anaemia, haematinics (low ferritin)
Tumour markers: CEA which is useful for monitoring - NOT a diagnostic tool
Colonoscopy
CT colonoscopy/ colonography
What other imaging tests are done for suspected colorectal cancer?
MRI pelvis - rectal cancer
CT chest/abdo/pelvis
What are the differences between a colonoscopy and a CT colonoscopy?
Colonoscopy
•Can visualize lesions < 5mm
•Small polyps can be removed
•Reduced cancer incidence
•Usually performed under sedation
CT colonoscopy/colonography
•Can visualize lesions > 5mm
•No need for sedation
•Less invasive, better tolerated
•If lesions identified patient needs colonoscopy for diagnosis
What is the primary management option for colon cancer?
Surgery
What is the treatment plan for a obstructing colon carcinoma in the right side and transverse colon?
Resection and primary anastomosis
What are the treatment options for an obstructing colon carcinoma in the left side colon?
Hartman’s procedure. Primary anastomosis, palliative stent
What is the aetiology of 70-90% of primary liver cancer?
70-90% have underlying cirrhosis
What is the optimal treatment for primary liver cancer?
Surgical excision with curative intent
In the treatment of primary liver cancer via surgical excision with curative intent, what is the 5 year survival rate and how does this compare to the survival rate without this treatment?
5yr survival >30%, without surgical excision is <5%
What is another name for primary liver cancer?
Hepatocellular carcinoma
What is the underlying aetiology of gallbladder cancer?
Unknown
What is the median survival rate for gallbladder cancer without Rx?
5-8mnths
Is systemic chemotherapy effective against gallbladder cancer or hepatocellular carcinoma?
Neither
What is the optimal treatment for gallbladder cancer and how many patients are suitable for this?
Surgical excision , <15%
What are the risk factors that cause cholangiocarcinoma?
PSC and UC, liver fluke, choledochal cyst