Gastro Cancers Flashcards by Rhiannon Heath

What are the layers of the bowel moving from lumen outwards ?

Mucosa
Submucosa
Muscularis propria
subserosa
Serosa

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What is the muscularis propria comprised of ?

A thick layer of muscle that lies deep to the submucosa.
Inner ring of circular fibres and outer ring of longitudinal bundles

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What are some risk factors of colorectal cancer ?

Age
Family history
Genetic syndromes ( familial adenomatous polyposis & hereditary nonpolyposis colorectal cancer )
Previous history of colorectal cancer or polyps
IBD
Poor diet
Obesity

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what is familial adenomatous polyposis ?

An inherited autosomal dominant pattern that is caused by a mutation in the APC gene. This is a tumour suppressor gene which causes a loss of function mutation resulting in the decreased ability to prevent the development of tumours.

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What is hereditary nonpolyposis colorectal cancer ?

Inherited autosomal dominant pattern and is caused by a mutation in a DNA mismatch repair gene.

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What are some protective factors of colorectal cancer ?

NSAIDs
Statins
COCP

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What are some screening modalities for colorectal cancer ?

Faecal immunotherapy testing ( FIT )
Colonoscopy
Flexible sigmoidoscopy

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What is the most common type of colorectal cancer ?

Adenocarcinoma

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How does colorectal adenocarcinoma arise ?

From gland cells that line the wall of the colon or rectum and produce mucus

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What are some signs, symptoms and complications of colorectal cancer ?

Bowel habit changes
Tenesmus
Blood in stool
Fatigue
Nausea or vomiting
Loss of appetite
Weight loss
Bowel obstruction or perforation

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What are some signs and symptoms that suggest colorectal cancer has spread ?

Hepatomegaly
Jaundice
Ascites
SOB

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What lab investigations should be performed for colorectal cancer ?

FBC
FIT
LFT
CEA levels
U&Es

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What imaging should be performed for colorectal cancer ?

Colonoscopy
AXR and CXR
CT chest abdo pelvis
USS liver if suspicion of spread

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Other than imaging and lab tests what else should be performed when suspecting colorectal cancer ?

Biopsy

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What are some management options for colorectal cancer ?

Surgery ( local excision, bowel resection, colostomy )
Palliative surgery
Chemotherapy
Radiation therapy
Targeted therapy

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What are some side effects associated with bowel resection ?

Pain
Bleeding
Thrombosis
Paralytic ileus
Adhesions
Anastomotic leak
Infection

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What are some side effects from chemotherapy for colorectal cancer ?

Bone marrow suppression
Diarrheoa
Skin changes
Sore mouth
Nausea and vomiting
Loss of appetite

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What are some side effects of radiotherapy fro colorectal cancer ?

Diarrheoa
Incontinence
Bowel obstruction
Urinary frequency

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What are some pathohistological factors associated with colorectal cancer that result in a worse prognosis ?

Positive surgical margins
Lymphovascular invasion
Higher pathological grade
Signet ring cell adenocarcinoma
Small cell carcinoma
Genetic mutations

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what are the 2 most common types of oesophageal cancer ?

Squamous cell carcinoma
Adenocarcinoma

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What are some differences between adenocarcinoma and squamous cell carcinoma in the oesophagus ?

Squamous - extensive local growth
Adenocarcinoma - less locally invasive but spreads more rapidly to lymph nodes ( lower 1/3 is affected )

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What are some risk factors for oesophageal cancer ?

Male
Higher age
Radiation exposure therapy
Obesity
Barrett’s oesophagus
Smoking

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What is Barrett’s oesophagus ?

Repetitive regurgitation of gastric contents irritates the oesophagus squamous mucosa causing inflammation. This can cause the squamous cells to transform into glandular epithelium which is called Barrett’s oesophagus.

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How does oesophageal cancer present ?

Dysphagia
Weight loss

Rare - odynophagia, recurrent vomiting, hoarseness of voice

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Why does hoarseness of the voice occur in oesophageal cancer ?

If the recurrent laryngeal nerve is involved

Upon physical examination what can be detected in oesophageal cancer ?

Palpable mass Lymphadenopathy Organomegaly Cardio resp abnormalities in advanced disease

What lab investigations should be performed when suspecting oesophageal cancer ?

FBC U&E’s LFTs Tumour markers - CEA and CA19-9

What are some investigations ( exclusion lab tests ) for oesophageal cancer ?

Endoscopic USS Biopsy Bronchoscopy CT chest abdo

What is the management of oesophageal cancer ?

Endoscopic therapy Surgery Chemotherapy and radiotherapy Metastatic disease - targeted therapy ( palliative )

What are some morbidities from treatment for oesophageal cancer ?

Surgical complications Radiation toxicity

What are some toxicities from using radiotherapy as a treatment for oesophageal cancer ?

Oesophagitis Dysphagia Nausea and vomiting Dehydration Fatigue Dermatitis Changes in gastric motility and emptying

What is the gastric cardia ?

Region of the stomach near the gastroesophageal sphincter junction

What is the fundus of the stomach ?

Part of the stomach located superior to the level of the gastroesophageal sphincter junction

What is the pylorus of the stomach ?

Most distal portion of the stomach

What is the pyloric sphincter ?

It regulates the passage of chyme from the pylorus to the duodenum.

What is the lesser curvature of the stomach ?

Forms the medial border of the stomach and attaches to the liver by the lesser omentum.

What is the greater curvature of the stomach ?

Attached to the diaphragm, spleen, transverse colon by the greater omentum.

What is the vascular supply of the stomach derived from ?

Branches of the celiac artery which arises from the aorta at the level of T12/L1.

What is the most common type of stomach cancer ?

Adenocarcinoma

What are some modifiable risk factors for gastric cancer ?

H.Pylori and EBV Smoking Alcohol consumption Obesity Radiation exposure

What are some non-modifiable risk factors for gastric cancer ?

Race / ethnicity Male Age Family history Genetic conditions

What are the most common symptoms and signs of gastric cancer ?

Abdo pain Weight loss Dysphagia Persistent vomiting Early satiety

What investigations should be performed when suspecting gastric cancer ?

FBC U&Es LFT’s CEA and ca19-9 tumour markers Endoscopy PET/CT Ct chest abdo pelvis

What are some management options for gastric cancer ?

Surgery Radiotherapy Systemic therapy

If gastric cancer is metastatic what management options are there ?

Chemo radiation for localised disease Systemic therapy

What is the oral cavity ?

A collection of sub sites of the upper aero digestive tract that play a key role in mastication, articulation, swallowing and breathing.

What are some modifiable factors for oral cavity cancer ?

Alcohol consumption Tobacco smoking Sun exposure Poor oral hygiene Chronic oral inflammation

What are some non-modifiable factors for oral cavity cancer ?

Male Age Past cancer history Family history Past radiation exposure

What is leukoplakia ?

White well defined keratotic patches

What is erythroplakia ?

Red mucosal plaques with ill defined borders

What are some premalignant oral lesions ?

Leukoplakia Erythroplakia Lichen planus

How does oral cavity cancer present ?

Leukoplakia Erythroplakia Dysphagia Odynophagia Halitosis

What is the management of oral cavity cancer ?

Surgery Radiation Chemotherapy Targeted therapy Immunotherapy

What are some modifiable risk factors of pancreatic cancer ?

Chronic pancreatitis - excessive alcohol consumption Smoking Diabetes Obesity

What are some non-modifiable risk factors of pancreatic cancer ?

Genetic predisposition Familial pancreatic cancer CF Pancreatic cysts

Who gets screened for pancreatic cancer ?

First degree relative with familial pancreatic cancer Patients who have peutz-jeghers syndrome Family with lynch syndrome Patients with hereditary pancreatitis

How does pancreatic cancer spread ?

Local lymphatic Haematogenous

How does pancreatic cancer present ?

Asymptomatic at first Jaundice Abdominal pain Weight loss

What are some laboratory tests to perform when suspecting pancreatic cancer ?

FBC, u&Es LFT’s Serum lipase Tumour marker CA19-9

What are some imaging options for pancreatic cancer ?

USS - first line CT - used to confirm positive US findings MRI ERCP - visualise the biliary tree and pancreatic ducts

What are some differentials for a pancreatic mass ?

Cyst Cancer Pancreatitis

What is the most common type of pancreatic cancer ?

Ductal adenocarcinoma

Where does the cancer arise from if it is an exocrine pancreatic neoplasm ?

Ductal and acinar cells

Where does the cancer arise from if it is an endocrine pancreatic neoplasm ?

Islet cells

What is the curative treatment for pancreatic cancer ?

Surgery

What surgery is performed if there is a head of the pancreas cancer ?

Whipple procedure

When is chemo/radiotherapy given in pancreatic cancer ?

Neoadjuvant Adjuvant Palliative

What surgery is performed for caecal cancer ?

Right hemicolectomy

What surgery is used for a transverse colon cancer ?

Extended right hemicolectomy

What surgery is performed for left colon cancer ?

Left hemicolectomy

What surgery is performed for sigmoid colon cancer ?

sigmoidcolectomy

What surgery is performed for rectal cancer ?

Anterior resection of the rectum

What alternative surgery can be performed if the rectal cancer is low ?

Abdominal-perineal excision of rectum

What histological staging is used for colorectal cancer and what are the stages ?

1 - within the bowel wall 2 - through the bowel wall 3 - lymph nodes involved 4 - distant mets

Which bowel cancer site is radiotherapy appropriate for ?

Rectal cancer Not colon

What are the palliative surgical options for bowel cancer ?

Stents Bypass Defunctioning stoma Palliative resection

Gastro Cancers Flashcards

(76 cards)