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GI Cancer Flashcards

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1
Q

Staging used + the levels of colorectal cancer

A

Duke’s staging used or TNM

Duke A = invasion into but not through bowel wall

Duke B = invasion through bowel but not nodes

Duke C = lymph nodes involved

Duke D = distant mets

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2
Q

Types of colorectal cancer + how best to manage each

A

SCC = anal + rectal (chemoradiotherapy)

Adenocarcinomas (mucinois or signet ring) further up (surgery)

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3
Q

When should you refer a pt with bowel symptoms?

A

Aged >40, rectal bleeding + change in bowel habit >6wks

Aged >60, rectal bleeding OR change in bowel habit

Any pt with RIF mass or rectal mass Iron deficiency anaemia

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4
Q

Epidemiology of colorectal cancer

A

4th most common cancer

Colon 1.5x more common than rectal

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5
Q

RF for colorectal cancer

A

Caucasian

Low SES

Increasing age

FH colorectal neoplasia/ carcinoma

IBD-UC, Obesity

Diet high in animal fat, poor in fibre

Polyposis syndromes (HNPCC, FAP, Gardner’s syndrome)

Gene mutations in APC gene

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6
Q

Symptoms of R colon cancer

A

Weight loss, anaemia, occult bleeding, mass in RIF, disease likely advanced

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7
Q

Symptoms of L colon cancer

A

Colicky pain, rectal bleeding, bowel obstruction, tenesmus, mass in LIF, early change in bowel habit

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8
Q

Symptoms of rectal tumours

A

Anaemia, occult bleeding, masses felt

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9
Q

Common mets for colorectal cancer

A

Bladder, ureters, small bowel + stomach, uterus/ vagina/ prostate

Lymphatics (mesenteric/ groin/ supraclavicular)

Blood - to lungs + liver

Transcoelemic - peritoneal seedlings

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10
Q

Investigations for colorectal cancer

A

Straight to colonscopy/ flexible sigmoidoscpy if red flag symptoms OR Seen by colorectal surgeon within 14 days

CT colonography - good for staging + identifying polyps

Measure CEA

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11
Q

Screening - what is offered + at what age for colorectal cancer

A

Flexi sig at 55 y/o

FOBT - between 60-74 y/o every 2 years

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12
Q

How is the diagnosis made for colorectal cancer?

A

Colonscopy with biopsy = gold standard

Flex sig if comorbidities

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13
Q

5 year survival by Dukes stage

A

A = 80%

B = 50%

C = 15-40%

D = 5%

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14
Q

Management + time frame to start treatment for colorectal cancer

A

Must start in 62 days

Surgery +- adjuvant chemo

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15
Q

Rectal cancer treatment

A

Anterior resection/ APER/ Hartmans

Neoadjuvant radiotherapy = then remove mesorectum

High risk = chemoradiation then surgery

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16
Q

SCC anal cancer treatment

A

5 weeks chemoradiotherapy

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17
Q

What is a TME?

A

Total mesorectal excision = complete removal of mesorectum

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18
Q

What is an AP resection?

A

Abdomino-perineal resection = for cancer in lower rectum/ anus.

Permanent colostomy

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19
Q

Complications of bowel cancer

A

Obstruction, perforation, surgical risks

Short bowel syndrome

Mets

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20
Q

Follow up after bowel cancer surgery

A

CT scan at 18 months, 3 and 5 years

Colonscopy within 12 months + 3 years after

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21
Q

When is chemo used?

A

Adjuvant chemo for Dukes C

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22
Q

Types of oesophageal cancer

A

Mostly epithelial, SCC or AC

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23
Q

RF for oesophageal cancer

Study These Flashcards
A

AC = caucasian males

SCC = smokers + alcohol drinkers

>60 y/o

Males

Barrett’s oesophagus

Tylosis (hyperkeratosis) + Patterson-Brown-Kelly syndrome

Obesity, FH of hiatus hernia

24
Q

Red flag symptoms for oesophageal cancer

Study These Flashcards
A

Dysphagia Vomiting Weight loss Retrosternal pain Hiccups Hoarseness

25
Signs of oesophageal cancer
Odynophagia Malaena Lymphadenopathy
26
Investigations for oesophageal cancer
Urgent endoscopy with biopsy EUS for local spread CXR + CT for mets FDG-PET for mets - more accurate Double contrast barium swallow
27
Management of oesophageal cancer
Surgery alone (endoscopic mucosal resection = early, oesophagectomy = late) +- chemo + radiotherapy (neo-adjuvant) Squamous cell cancer = chemoradiotherapy +/- surgery
28
Types + locations of gastric cancer
50% involve pylorus, 25% lesser curve + 10% cardia 2-8% are lymphomas (MALT) Adenocarcinomas most common
29
RF for gastric cancer
M:F 8:1 Low SES H pylori High salt foods Low fruit + veg Smoking Gastritis, pernicious anaemia FH Blood group A
30
Red flag symptoms for gastric cancer
Advanced = dyspepsia, weight loss, vomiting, dysphagia, anaemia Early = uncomplicated dyspepsia
31
Incurable signs of gastric cancer
Epigastric mass, hepatomegaly, jaundice, ascites, Troisier's sign (enlarged L supraclavicular node (Virchow's node)), acanthosis nigricans
32
Investigations for gastric cancer
Flexible endoscopy + biopsies FDG-PET-CT for staging, EUS for assessing tumor depth + lymph node involvement Consider staging laparoscopy (if potentially curable) HER2 testing for metastatic oesophago-gastric adenocarcinoma
33
Management of gastric cancer
Surgery + neo-adjuvant + adjuvant chemo/ chemoradiotherapy Distal tumours = subtotal gastrectomy Proximal = total gastrectomy Offer nutritional support for pts having radical treatment (enteral or parenteral) Palliative chemo (trastuzumab for pts with HER2+ adenocarcinoma)
34
Types of pancreatic cancer
Endocrine = pancreatic neuroendocrine tumours (PNETs) = 5% Exocrine = 90% infiltrating-ductal carcinomas
35
RF for PNETs
MEN1 mutation Von Hippel-Lindau Neurofibromatosis type 1 Female
36
RF for exocrine pancreatic cancer
Smoking Diet (high BMI, high red meat, low fruit +veg) Pancreatitis FH Familial cancer syndromes = BRCA, Peutz-Jeghers syndrome, Lynch syndrome
37
Red flag symptoms for PNETs
Insulinoma = hypoglycaemia Gastrinoma = zollinger-ellison (severe peptic ulceration + diarrhoea) Glucogonama = diabetes symptoms
38
Red flag symptoms for exocrine pancreatic tumours
Painless, progressive, obstructive jaundice, steatorrhea (if in head) Non specific symptoms if in body or tail: abdo pain, obstructive jaundice, acute pancreatitis, weight loss, steatorrhoea, N+V
39
What is courvoisier's sign?
Palpable gallbladder in the presence of painless jaundice
40
Management of PNETs
Surgery if resectable Chemo, ablation, chemoembolisation, biotherapy
41
Management of exocrine pancreatic tumours
Surgical resection = only 10-20% suitable Use Whipple's Chemo + stenting + RT Chemo for metastatic pancreatic cancer
42
When to refer a pt with suspected pancreatic cancer?
Aged over 40 + jaundice Non-urgent CT = \>60 with weight loss + diarrhea, back pain, abdo pain, N+V, constipations or new-onset diabetes
43
How does oesophageal cancer appear on endoscopy (early v late)?
Early = superficial plaques, nodules, ulcerations Advanced = strictures, ulcerated masses or large ulcerations
44
When to refer a pt for endoscopy if ?oesophageal cancer?
Dysphagia or \>55 with weight loss + upper abdo pain, reflux or dyspepsia Non urgent endoscopy for people with haematemesis
45
When to refer a pt with ?stomach cancer?
Upper abdo mass Dysphagia \>55 with weight loss + upper abdo pain, reflux or dyspepsia Endoscopy Non-urgent = haematemesis
46
When to refer someone with ?gallbladder cancer?
US with pts with upper abdo mass consistent with enlarged gallbladder
47
When to refer people with ?liver cancer?
US for people with enlarged liver
48
Investigations for pancreatic cancer
US is highly sensitive for biliary tract dilation + pancreatic masses \>3cm ERCP - therapeutic not diagnostic MRCP CT for pts without jaundice (when pancreatitis is a differential) EUS if jaundiced, upper abdo pain + weight loss, if there is no lesion of US or CT
49
Staging for pancreatic cancer
When mass is found on CT or US, triple phase helical CT used to assess mets Resectable vs unresectable Unresectable if: extensive lymphatic involvement, distant mets, direct involvement of superior mesenteric artery, inferior vena cava, aorta, celiac axis or hepatic artery CA19.9 to assist in prognosis EUS-guided FNA for biopsy in unresectable or neo-adjuvant Tx
50
Link to germline mutations in pancreatic cancer
4-20% of pancreatic cancer have germline mutations in cancer predisposition genes
51
What are the common liver lesions?
* Hepatic hemangioma * Focal nodular hyperplasia * Hepatic adenoma * Idiopathic noncirrhotic portal hypertension (including nodular regenerative hyperplasia) * Regenerative nodules * Hepatocellular carcinoma * Cholangiocarcinoma * Metastatic disease
52
S+S of liver tumors
Asymptomatic Pain/ palpable mass Complications such as variceal hemorrhage or ascites Paraneoplastic syndrome
53
What paraneoplastic syndrome occurs with liver cancer?
Hypoglycaemia, erythrocytosis, hypercalcaemia, severe diarrhea
54
What is LI-RADS?
Estimates likelihood of HCC + malignancy + classifies lesions
55
Management of HCC
Surgical resection but most aren't eligible Liver transplant Thermal ablation or radiation if unsuitable for surgery
56
4 categories of anal cancer
Tumours developing from lining mucosa (glandular, transitional + squamous) Tumours on hair bearing skin (anal margin cancer) Adenocarcinoma arising from glandular sections (rare) Primary rectal SCC (v rare)
57
Management of adenocarcinoma of anal canal
Surgery

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