alimentary disease

Question 1

feature of primary cancers

Answer 1

arise directly from cells in organ e.g. bowel cancer

Question 2

feature of secondary cancers

Answer 2

spread from another organ, directly of by other means (blood or lymph) e.g. liver cancer

Question 3

locations of GI cancers

Answer 3

oesophagus, stomach, biliary system, pancreatic, colorectal (small intestine, large intestine, colon, anus)

Question 4

2 types of oesophageal cancer

Answer 4

adenocarcinoma (most common), squamous cell carcinoma

Question 5

features of adenocarcinoma (cell, location, related to, developed world)

Answer 5

from metaplastic columnar epithelium, lower 1/3 oesophagus, related to acid reflux, more developed world

Question 6

what else are adenocarcinomas associated with

Answer 6

obesity, smoking, alcohol, males

Question 7

development of adenocarcinoma

Answer 7

normal epithelium → hyperplasia → adenomatous polyps → adenocarcinoma → metastasis

Question 8

features of squamous cell carcinoma (cell, location, pathway, developed world)

Answer 8

normal oesophageal squamous epithelium, upper 2/3s oesophagus, acetaldehyde pathway, less developed world

Question 9

main causes of squamous cell carcinoma

Answer 9

smoking, alcohol, ingestic caustic substances

Question 10

why is there a link of squamous cell carcinoma with alcohol and which population does it affect most

Answer 10

due to acetaldehyde metabolite, which damages epithelial cells; more common in Asians due to muations in acetalydehyde dehydrogenase

Question 11

development of squamous cell carcinoma

Answer 11

normal epithelium → metaplasia → dysplasia → severe dysplasia → development of squamous cell carcinoma → metastisis

Question 12

3 early symptoms of squamous cell carcinoma

Answer 12

difficulty and pain when swallowing, weight loss due to lack of nutrition, pain in breast bone and stomach, or feeling of reflux

Question 13

2 later symptoms of squamous cell carcinoma

Answer 13

nausea, vomiting and regurgitation of food, vomiting blood due to trauma of tumour

Question 14

3 clinical investigations of squamous cell carcinoma

Answer 14

endoscopy, CT scan (check for metastasis), endoscopic ultrasound (determine level of invasion)

Question 15

2 treatments for squamous cell carcinoma

Answer 15

surgery (early can remove tumour, late must remove part of oesophagus, chemotherapy and radiotherapy

Question 16

5 investigations for colon cancer

Answer 16

x-ray, CT, barium enema, colonoscopy, CT virtual colonoscopy

Question 17

8 risk factors for colorectal cancer

Answer 17

family history, inflammatory bowel disease (Crohns, ulcerative colitis), familial adenomatous polyposis, hereditary non-polposis colon, Lynch syndrome, uncontrolled ulcerative colitis, age, previous polyps

Question 18

early symptoms of pancreatic cancer

Answer 18

depression, abdominal pain and glucose intolerance

Question 19

advanced symptoms of pancreatic cancer

Answer 19

weight loss, jaundice, ascites and gall bladder obstructions

Question 20

5 risk factors of pancreatic cancer

Answer 20

smoking, drinking, obesity, family, multiple endocrine neoplasia

Question 21

where does colorectal cancer occur

Answer 21

colon or rectum

Question 22

main causes of colorectal cancer

Answer 22

old age, lifestyle factors including diet (link to consumption of red meat and processed meat), alcohol, obesity, tobacco smoking, lack of physical activity

Question 23

screening of colorectal cancer

Answer 23

faecal sample testing for presence of blood

Question 24

locations of colorectal cancer with % frequency

Answer 24

caecum (19%), ascending colon (17%), transverse colon (11%), descending colon (6%), sigmoid colon (22%), rectum (25%)

Question 25

7 symptoms of colorectal cancer

Answer 25

worsening constipation, blood in stool (can be associated with many other disorders), loss of appetite, loss of weight, nausea and vomiting, rectal bleeding, anaemia, acute intestinal obstruction

Question 26

2 treatments for colorectal cancer

Answer 26

surgery (removal of tumour via colonscopy or laparotomy, which may cause colostomy), chemotherapy and radiotherapy

Question 27

epithelial cells and associated cancer

Answer 27

squamous (squamous cell carcinoma), glandular epithelium (adenocarcinoma)

Question 28

neuroendocrine cells and associated cancer

Answer 28

enterochromaffin (carcinoid tumours), interstitial cells of Cajal (GI stromal tumours)

Question 29

connective tissue and associated cancer

Answer 29

smooth muscle (leiomyoma or leiomyosarcomas), adipose (lipomas)

Question 30

causes of dysphagia in oesophageal cancer

Answer 30

achalasia (failure of oesophageal sphincter to release), obstruction

Question 31

why associated symptom of weight loss with oesophageal cancer

Answer 31

sicchasia and dysphagia

Question 32

progression from GERD (gastro-oesophageal reflux disease) to cancer

Answer 32

oesophagitis (inflammation) → Barrett's oesophagus (metaplasia: squamous to columnar) → dysplasia → carcinoma (neoplasia)

Question 33

progression from normal epithelium to colon carcinoma

Answer 33

normal epithelium → hyperproliferative epithelium (aberrant cryptic foci with COX-2 overexpression) → small adenoma → large adenoma → colon carcinoma

Question 34

what can influence normal epithelium to hyperproliferative epithelium

Answer 34

aspirin, other NSAIDs, folate Ca2+

Question 35

what can influence hyperproliferative epithelium to small adenoma

Answer 35

aspirin, other NSAIDs

Question 36

what can influence small adenoma to large adenoma

Answer 36

oestrogen, aspirin, other NSAIDs

Question 37

3 features of pathology of colorectal cancer

Answer 37

not monogenic; sequence of genetic errors; inheritance so not simple Mendelian

Question 38

colorectal cancer: advantages and disadvantages of abdominal x-ray

Answer 38

cheap, easy, quick; not sensitive or specific for obstruction

Question 39

colorectal cancer: advantages and disadvantages of plain CT

Answer 39

quick, easy, see large lesions; may miss smaller lesions, no tissue, no therapy

Question 40

colorectal cancer: advantages and disadvantages of barium enema

Answer 40

reasonable sensitivity and specificity; time intensive, technically demanding, unacceprable to patients

Question 41

colorectal cancer: advantages and disadvantages of colonoscopy

Answer 41

safe, relatively quick, high sensitivity, able to obtain tissue; take bowel prep which causes 2 days of iatrogenic diarrhoea, small risk of perforation, risk of dehydration

Question 42

features of virtual CT

Answer 42

modified bowel prep so stool is "tagged" using Bismuth; computer aided subtraction of faeces to create images

Question 43

colorectal cancer: advantages and disadvantages of virtual CT

Answer 43

quick, easy, reduced bowel prep more tolerable, as good as colonoscopy for lesions >6mm; unable to obtain tissue or remove lesions

Question 44

symptoms of pancreatic cancer

Answer 44

non specific symptoms (Virchow's triad: 70% pain, 10% anorexia, 10% weight loss)

Question 45

jaundice caused by pancreatic cancer

Answer 45

post-hepatic due to tumour obstruction