gi cancer

Question 1

what are the two types of oesophageal cancer?

Answer 1

1. adenocarcinomas
2. squamous cell carcinoma

Question 2

where do adenocarcinomas occur?

Answer 2

• lower 2/3 of oesophagus

Question 3

where do squamous cell carcinomas occur?

Answer 3

• upper 2/3 of oesophagus

Question 4

what are the risk factors for adenocarcinomas?

Answer 4

• barretts oesophagus
• obesity

Question 5

who is more likely to get adenocarcinomas?

Answer 5

• males
• 60-70

Question 6

what are the risk factors for squamous cell carcinomas?

Answer 6

• smoking
• alcohol
• nitrous amines

Question 7

who is more likely to get squamous cell carcinomas?

Answer 7

males
60 - 70

Question 8

describe the pathology behind oesophageal cancers

Answer 8

1. oesophagus lined by squamous epithelium
2. stomach lines by columnar glandular epithelium
3. oesophagus epithelium undergoes metaplasia to stomach epithelium

Question 9

what are the early symptoms for oesophogeal cancers?

Answer 9

no symptoms
only presents when advanced

Question 10

what are the later symptoms for oesophageal cancers?

Answer 10

Anaemia
Loss of weight
Anorexia
Recent sudden symptoms worsen
Melena/ haematemesis
Swallowing progressive difficulty
( if swallowing is NON progressive then suggests achalasia)
REMEMBER IT USING ALARMS

Question 11

What is melena?

Answer 11

passage of black tarry stools

Question 12

how are oesophageal cancers diagnosed?

Answer 12

-OGD (oesophago Gastro Duodenoscopy - basically endoscopy) + biopsy
- with barium swallow
-CT/PET
-for staging

Question 13

how are oesophageal cancers treated?

Answer 13

-if medically fit- chemo/ radio + surgery
- if unfit- palliative care

Question 14

what are gastric cancers?

Answer 14

stomach cancers

Question 15

what are most gastric cancers?

Answer 15

adenocarcinomas ( 95%)

Question 16

what do most gastric cancers involve?

Answer 16

most involve pyloris of stomach

Question 17

what are type 1 Gastric cancers?

Answer 17

• well differentiated
• better prognosis
• more common

Question 18

what are type 2 gastric cancers?

Answer 18

• undifferentiated
• signet ring carcinomas
• worse prognosis

Question 19

who are more likely to get gastric cancers?

Answer 19

• Eastern Europe + Asia
• smoking
• males
• falling incidence

Question 20

what are the causes of gastric cancers?

Answer 20

• H Pylori
• smoking
• CDH-1 mutation ( mutated cadherin gene- 80% risk)
• pernicious anaemia- autoimmune chronic gastritis

Question 21

what are the symptoms of gastric cancer?

Answer 21

• severe epigastric pain
  · Anaemia
  · Weight loss
  -Progressive dysphagia ·
  Tired all the time

Question 22

what are the signs of gastric cancer?

Answer 22

Jaundice
↳ liver metastases
Krukenburg tumour
↳ ovarian metastases
Lymph node spread
↳ virchows node - supraclavicular
↳ Sister Mary Joseph node
↳ umbilical

Question 23

how are gastric cancers diagnosed?

Answer 23

-Gastroscopy + biopsy
· CT/MRI for staging
· PET for metastases

Question 24

how are gastric cancers treated?

Answer 24

• surgery ( gastroectomy) + ECF chemo regimen

Question 25

why is there a low chance of small intestine carcinomas?

Answer 25

-as SI is tumour resistant - most adenocarcinomas

Question 26

what are the risk factors for small intestine carcinomas?

Answer 26

- chronic SI disease - crohns, coeliac

Question 27

how are small intestine carcinomas diagnosed and treated?

Answer 27

same as gastric

Question 28

what does colorectal polyps and cancer affect?

Answer 28

- large bowel cancer

Question 29

what are colorectal polyps and cancer usually?

Answer 29

- usually adenocarcinomas

Question 30

what is the pre cursor for adenocarcinomas?

Answer 30

adenoma

Question 31

what do adenocarcinomas usually metastases to?

Answer 31

liver and lung

Question 32

describe the activity of adenocarcinomas

Answer 32

mostly spontaneous and benign but can progress to cancer

Question 33

who does colorectal polyps and cancer affect?

Answer 33

-60-65 - 3rd most common cancer - males

Question 34

describe the pathology behind colorectal polyps and cancer

Answer 34

· Normal epithelium--> adenoma-->colorectal adenocarcinoma-> metastatic colorectal adenocarcinomas

Question 35

what are the risk factors for colorectal polyps and cancer?

Answer 35

1. Familial adenomatous polyposis 2. hereditary non polyposis colorectal cancer 3. adenomas/ polyps 4. alcohol/ smoking/ UC

Question 36

how does familial adenomatous polyposis increase risk of colorectal polyps and cancer?

Answer 36

-Autosomal dominant condition -APC gene mutation -> 1000s of duodenal polyps - inevitably will get colorectal cancer

Question 37

how does hereditary non polyposis colorectal cancer increase risk of colorectal polyps and caner?

Answer 37

Autosomal dominant condition MSH-1 mutation : DNA mismatch repair gene rapidly increases progression of cancer

Question 38

what are the symptoms of colorectal polyps and cancer?

Answer 38

- mostly in distal colon - LLQ pain - bloody mucus stools - tenesmus

Question 39

how are colorectal polyps and cancer diagnosed?

Answer 39

1. FIT test (faecal immunological test) ↳ screening for micro blood particles in poo 2. Colonoscopy + biopsy 3. classification -> T N M staging

Question 40

how are colorectal polyps and cancer treated?

Answer 40

surgery and chemo