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Flashcards in Benign + malignant tumors of the intestine Deck (36):
1

For malignant oesophageal tumors, where are the squamous cell tumors usually?

the middle third of the oesophagus

2

What do adenocarcinomas arise from in the oesophagus?

Barrett's metaplasia

smoking + obesity are also risk factors

(and they are usually in the lower third of the oesophagus)

3

clinical features malignant oesophageal carcinoma

progressive dysphagia
weight loss

4

Investigations for malignant oesophageal carcinoma

oesophagoscopy with biopsy

CT: extra-oesophageal disease?

5

Mx oesophageal carcinoma

Poor prognosis 10% 5YSR

Surgical resection with pre-op chemo for localised tumors

Expandable metal stents can provide relief of dysphagia for palliative patients

6

Gastric cancer associations

H. pylori

Smoking
Diets (lots of salt, little fruit + veg)
FH

7

which part of the stomach do tumors normally occur and what cell type?

antrum

adenocarcinomas

8

How does H.pylori lead to gastric carcinoma?

h. pylori --> chronic gastritis --> intestinal metaplasia --> dysplasia --> carcinoma

9

Symptoms gastric cancer

Pain similar to peptic ulcer pain

More advanced disease: nausea, anorexia and weight loss

10

Signs gastric cancer

epigastric mass

lymph node sometimes felt in supraclavicular fossa (Virchow's node)

mets: ascites + hepatomegaly

11

Ix gastric cancer

Initial: Gastroscopy + biopsy

Staging: CT, EUS (endoscopic ultrasound)

12

Mx gastric cancer

Surgery if operable

Lymphadenectomy

Pre-op chemo

13

What are the greatest risk factors for colorectal cancer?

1. increasing age

2. family history

14

What is HNPCC

Hereditary nonpolyposis colorectal cancer

Accelerated progression from adenoma to CRC.
Onset in 4th decade

15

What is familial adenomatous polyposis

Numerous colorectal polyps develop in teenage years --> cancer by 20s

Epithelial up regulation and adenoma

Increased risk of extracolonic malignancies

16

Polyp

an abnormal growth of tissue projecting into the intestinal lumen from the normally flat mucosal surface

most polyps in the colon are adenocarcinomas

17

colorectal cancer spread

by direct invasion through the bowel wall, later invasion of blood vessels + lymphatics, spread to the liver and lung

18

Vogel-stein hypothesis colorectal cancer

hyper proliferation of mucosa
increasing size of polyp
5 x genetic mutations in growth

--> cancer!!!

19

where are most colorectal tumors? and presentation

left side of the colon
retal bleeding + stenosis
increasing intestinal obstruction

20

presentation of carcinoma of the caecum and ascending colon

iron deficiency anaemia (due to loss of blood from the bowel)

right iliac fossa mass

21

Ix colorectal cancer

**Colonoscopy with biopsies

FBC: anaemia, liver function

Radiology, PET scan

Faecal occult blood tests: used in population screening studies

22

Mx colorectal cancer

Surgical: tumor resection and end-to-end anastomosis of bowel

RT, CT

23

Who do you screen for colon cancer?

high risk individuals

from family colon syndromes or with a 1st degree relative developing colon cancer aged

24

what causes hepatocellular carcinoma? (HCC)

chronic liver disease
cirrhosis, particularly due to viral hepatitis

25

clinical features HCC

weight loss, anorexia, fever, ascites and abd pain

focal lesion

26

Ix HCC

US/CT shows large filing defects
Serum AFP (alpha-fetoprotein) may be raised

Biopsy if there is diagnostic doubt

27

Mx HCC

surgical resection or liver transplantation

28

Aetiology pancreatic carcinoma

Hereditary and environmental factors

chronic pancreatitis is also pre-malignant

29

What symptoms does cancer affecting the head of the pancras or ampullae of Vater present with?

painless jaundice from obstruction of CBD, and weight loss

examination: jaundice with characteristic scratch marks + a distended palpable gallbladder

30

Courvoisier's law

if in a case of painless jaundice the gallbladder is palpable, the cause will not be gallstones

in gallstone disease CI and fibrosis prevent distension of the gallbladder

31

How does cancer of the body or tail of the pancreas present?

abd pain, weight loss and anorexia

32

Ix pancreatic cancer

US: dilated bile ducts and a mass lesion

MRI + EUS used for staging

33

Mx pancreatic cancer

Surgical resection = the only hope of cure.
But few its have resectable disease at diagnosis

CT + RT

palliative Tx: endoscopic stenting across obstructed distal CBD to relieve obstructive jaundice

34

Imaging shows a bile duct stricture, a hilar mass or multiple mets

cholanguicarcinoma, cancer of the bile ducts

35

adenoma

benign tumour formed from glandular structures in epithelial tissue

36

what does faecal occult blood test do?

helps to diagnose bleeding disorders of the gut