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GI cancer Flashcards

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1
Q

cancers of the GI tract

A 
Splenic – less
Liver – frequent 
Small bowel tumour – less
Large – more 
parotid gland 
salivary gland 
oesophagus 
stomach 
pancreas
rectum 
anus
appendix
LI
duodenum 
gall bladder
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2
Q

why is cancer important

A

it is common - so is GI specifically
serious - causes a lot of deaths
it is what people are the most worried about

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3
Q

what is cancer

A

a disease caused by an uncontrolled division of abnormal cells in a part of the body

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4
Q

primary cancer

A

arising form cells in an organ directly

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5
Q

secondary/met

A

spread from another organ

direct invasion/metastasis

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6
Q

is GI cancer primary or secondary

A

bowel - primary

liver - secondary - blood supply

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7
Q

types of epithelial cells and their location

A

Squamous – oesophagus and rectum

Glandular epi – most of the way through

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8
Q

epithelial cancers

A

Squamous Cell Carcinoma

Adenocarcinoma

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9
Q

gastrinmtestinal tumours

A

benign

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10
Q

connective tissue and their canccers

A

Smooth muscle - Leiomyoma/leiomyosarcomas

Adipose tissue - Lipomas

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11
Q

neuroendocrine cells ands their tumours

A

Enterochromaffin cells - Carcinoid tumours

Interstitial cells of Cajal - Gastrointestinal Stromal Tumours

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12
Q

most common GI tumour

A

adenocarcinoma

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13
Q

what things do you need to ask someone who has dysphagia (difficulty swallowing)

A

Textures of what people can swallow
obstruction/failure in peristaltic mechanisms
Cancer – progressive, start with big bits and then to yoghurts whereas Neuromuscular – spontaneously cant do both
Vom – food cant even get down tubv
Weight loss – is worrying, not getting any food

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14
Q

what are risk factors for oesophageal cancer

A

previous reflux, overweight, smoking, alcohol

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15
Q

where is columnar epithelium in the oesophagus

A

near stomach

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16
Q

muscle through the oesophagus

A

progresses from skeletal to smooth

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17
Q

describe oesophageal cancer

A

From metaplastic columnar epithelium
Lower 1/3 of oesophagus
Related to acid reflux = recurrent damage to mucosa from acid
More developed world = obesity

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18
Q

why is being overweight a risk factor for acid reflux

A

increase abdominal pressure = force food back up

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19
Q

describe squamous cell carcinoma

A

From normal oesophageal squamous epithelium
Upper 2/3
Acetaldehyde pathway - increased by smoking and alcohol = damage epi
Less developed world - mutations in acetaldehyde dehydrogenase enzyme = build up of metabolite - increase risk of cancer

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20
Q

symptoms of acid reflux

A

Long history of heart burn, regurgitation and burping - stimulate oesophagus, swallow air - reflux = it comes back up

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21
Q

describe endoscopy

A

Pass tube down mouth – visually see oesophagus and stomach

Conscious

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22
Q

how does acid reflux progress to cancer

A 
chronic exposure to acid
injury, ongoing inflammation, cytokine drive 
15% pop have GORD
5-13% of them - Barrett's (metaplasia) 
5% per year - dysplasia 
0.5%-30% - carcinoma - neoplasia
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23
Q

barretts oesophagus

Study These Flashcards
A

expression of cells where not normal eg columnar where expect to see squamous
metaplasia

24
Q

barretts oesophagus on endoscopy

Study These Flashcards
A

Red- columnar

Black hole – gastroesophageal junction

25
risk factors for colorectal cancer
Family History - has to be really strong, first degree relatives <50yrs Specific inherited conditions FAP (Familial adenomatous polyposis), HNPCC (hereditary nonpolyposis colorectal cancer), Lynch Syndrome Uncontrolled Ulcerative Colitis Age Previous Polyps
26
histology of adenocarcinoma
densification of tissue
27
describe the progression to colorectal cancer
1. inhibited by NSAIDSs, folate ca. caused by APC mutation -> hyperproliferative epithelium, abberent cryptic foci 2. inhibited by NSAIDSs -> small adenoma 3. inhibited by NSAIDSs and oestrogen, casued by K-ras nmutation -> large adenoma 4. casued bt p53 mutation and loss of 18q -> colon cancer
28
appearance of polyps as the progess
secile - on the epi lining pedunculated Necrotic area – black and white bits – definitely colorectal
29
pathology of colorectal cancer
not single gene sequence fo genetic errors - APC< K-ras, p52, 18q affects the risk factors
30
symptoms of colorectal cancers
``` Asymptomatic (incidental anaemia) - routine blood test Change in Bowel Habit Diarrhoea more than constipation Blood in Stool Acute intestinal obstruction weight loss loss of appetite nausea and vomiting rectal bleeding anaemia ```
31
symptoms that are not associated with colorectal cancer
Rectal bleeding with anal symptoms - Itch, Soreness / discomfort, External lump, prolapse constipation alone abdominal pain with no obstruction
32
use of x ray to diagnose colorectal cancer
Cant see the bowel there is stifling appearance so proberly poo = constipation + cheap, easy, quick - low sensitivity and specificity, No use to pick up early disease
33
use of plane CT to diagnose colorectal cancer
+ Quick Easy See large lesions - May miss smaller lesions No tissue = No therapy
34
process of barium enema
barium liquid is instilled in LI, patient move around, then viewed Can do double – air next time – colon expand – see better
35
barium enema for colorectal cancer
+ Reasonable Sensitivity and Specificity - Time Intensive Technically demanding Unacceptable to patients
36
process of colonoscopy
Pump it all the way round recognise caecum by - appendix, ileoceacal valve, triradiate folds Difficult to move rigid tube though a tube that moves end of tube: video chip, irrigation channel, instrument channel - allow take samples, light
37
colonoscopy for colorectal cancer
``` + Safe Relatively quick High Sensitivity Able to obtain tissue - 2 days of iatrogenic diarrhoea Small risk of perforation (<1:2000) Risk of dehydration ```
38
process of CT virtual colonoscopy
Give something similar to barium – drink Put them in CT “tag” stool using Bismuth Technology to remove poo from bowel from the wall
39
CT virtual colonoscopy for colorectal cancer
+Quick Easy Reduced Bowel prep more tolerable As good as colonoscopy for lesions >6mm - unable to get tissue cant remove lesion
40
way to remove bleed
Current to burn through bv – so that the vessel doesn’t bleed – pick up polyp and take away Inject saline into wall – lift it away from wall – snair to remove it from the wall Scar will heal after day/2
41
problem with diagnosing pancreatic cancer
silent killer non-specific Virchow's traid - pain, anorexia, weight loss - Not a massive proportion of patients `
42
early symptoms of pancreatic cancer
Abdominal pain Depression Glucose intolerance - worry about the effect on the pancreas
43
late symptoms of pancreatic
Weight loss Jaundice Ascites Obstructed gall bladder - too late
44
outcome of pancreatic cancer
``` poor surgery curative on 20-25% cases 1 year survival 18% 5 year 2% only 20% suitable for resection ```
45
describe the surgery for pancreatic cancer
take away panc, duodenum,, gall bladder - put everything else back after
46
risk factors for pancreatic cancer
``` Smoking Drinking Obesity Family Especially rare conditions such as MEN - Presents with cancer in family with different sites ```
47
describe adenocarcinoma
``` from metastatic columnar epi lowe 1/3 oesophagus acid reflux - repeated damage to oesophagus related to obesity developed world ```
48
is adenocarcinoma more frequent in men or women
men | because of hormonal control in women
49
list the phases in the progression of ADENOCARCINOMA
Normal epithelium Hyperplasia - abnormal proliferation of epithelial cells Development of adenomatous polyps Development of adenocarcinoma Metastasis
50
list the phases in the progression of SQUAMOUS cell carcinoma
Normal epithelium Metaplasia - development of abnormal squamous cell Dysplasia - proliferation of abnormal cells Severe dysplasia - almost all cells are abnormal Development of squamous cell carcinoma Metastitsis
51
symptoms of oesophageal cancer
when >50% circumference of oesophagus is cancerous - narrowing of the tube - Difficulty and pain when swallowing Weight loss - due to lack of nutrition Pain in the breast bone and stomach, or a feeling of reflux later symptoms: Nausea, vomiting, and regurgitation of food Vomiting blood, due to trauma to the tumour
52
what does a CT check for
metastasis
53
treatment of oesophageal cancer
surgery - tumour removed from oesophageal wall oesophagectomy - remobval of part of the oesophagus chemo and radiotherapy
54
cause of colorectal cancer
diet alcohol tobacco lack of physical activity
55
treatment of colorectal cancer
surgery - removal of tumour via colonscopy or laparotomy may result in removal of large parts of colon = colonstomy chemo and radiotherapy

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