GI Cancers

Question 1

What are primary vs secondary cancers?

Answer 1

Primary —> tumour arises directly from cells
Secondary —> tumour arises from metastasis

Question 2

What are the 6 types of GI tumours?

Answer 2

Epithelial cells:
- squamous —> squamous cell carcinoma
- glandular epithelium —> adenocarcinoma

Neuroendocrine cells:
- enteroendocrine —> neuroendocrine tumours
(NETs)
- interstitial cells of Cajal —> gastrointestinal stromal
tumours (GISTs)

Connective tissue:
- smooth —> leiomyoma/leiomyosarcoma
- adipose tissue —> liposarcoma

Question 3

How are GI cancers screened for?

Answer 3

Wilson & Junger criteria —> decides whether a disease
should be screened for
- Colorectal - FIT = Faecal Immunochemical Test
- detects Hb
- every 2 years for 60-74 year olds
- one-off sigmoidoscopy - remove polyps
- >55 year olds
- Oesophageal - regular endoscopy for patients with
Barrett’s oesophagus dysplasia
- Pancreatic/Gastric —> none meet W&J criteria
- Hepatocellular - regular US and AFP for high-risk
individuals with cirrhosis

+ genetic predisposition/strong FHx
- FAP = Familial adenomatous polyposis
—> yearly OGDs and colonoscopies
- Hereditary pancreatitis

Question 4

What are the 4 steps of cancer assessment?

Answer 4

1. Worrying symptoms presented to GP/A&E
   Identified via screening programme
2. 2-week-wait cancer pathway
3. Diagnostic tests
4. MDT meeting —> treatment plan

Question 5

Who are involved in the MDT of GI cancers? (7)

Answer 5

1. Pathologists —> cancer diagnosis via biopsy
   - histological typing —> cells
   - molecular typing —> mutations
   - tumour grade
2. Cancer Nurse Specialist
3. Surgeon
4. Radiologist —> reviews scans
   - radiological tumour stage (TNM)
   - re-staging after treatment
   - interventional radiology
5. Palliative Care
6. Gastroenterologist —> endoscopy
   - upper GI, lower GI, liver,
   pancreas
7. Oncologists —> decides cancer therapy
   - whether neoadjuvant or adjuvant to
   surgery (performance status)
   - whole team —> radical therapy, palliative therapy or
   palliative care

Question 6

What is the pathogenesis of oesphageal cancer?

Answer 6

Upper 2/3 —> squamous cell carcinoma
- oesophageal squamous epithelium
- commonest in developing

Lower 1/3 —> adenocarcinoma
- acid reflux —> metaplasia —> columnar epithelium
- commonest in developed

Question 7

What are the presentations of oesphageal cancer?

Question 8

How is oesphageal cancer diagnosed?

Question 9

How is oesphageal cancer treated?

Question 10

What is the pathogenesis of oesphageal cancer?

Question 11

What is the pathogenesis of gastric cancer?

Question 12

What are the presentations of gastric cancer?

Question 13

How is gastric cancer diagnosed?

Question 14

How is gastric cancer treated?