GI Cancers

Question 1

what is cancer

Answer 1

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

Question 2

what is primary cancer

Answer 2

Arising directly from the cells in an organ

Question 3

what is secondary cancer or metastasis

Answer 3

Spread to another organ, directly or by other means (blood or lymph)

Question 4

what is squamous cell carcinoma

Answer 4

from normal oesophageal squamous epithelium
Upper 2/3 (where stratified squamous epithelium is)
Alcohol metabolised = acetaldehyde is v toxic + carcinogen (more common in less developed world)

Question 5

what is adenocarcinoma

Answer 5

from metaplastic columnar epithelium
lower 1/3 of oesophagus
related to acid reflux (more common in developed world)

Question 6

what is the progression from reflux to cancer

Answer 6

oesophagitis (inflammation) to Barrett’s (metaplasia) to adenocarcinoma (neoplasia)

Question 7

How does Barrett’s go to cancer

Answer 7

Barrett’s metaplasia to low grade dysplasia to high grade dysplasia

Question 8

oesophageal cancer epidemiology

Answer 8

affects the elderly
more common in men (10:1)
9th most common cancer

Question 9

Is there high survival from oesophageal cancer?

Answer 9

presents late
dysphagia + weight loss
high morbidity
poor 5 yr survival <20%
mostly palliative

Question 10

what is the treatment plan for oesophageal cancer

Answer 10

Stage the cancer
CT/ laparoscopy
OGD if suspicious there is a tumour there
neo-adjuvant chemo for all adenocarcinomas + radical surgery

Question 11

what is colorectal cancer

Answer 11

most common GI cancer in western societies
generally >50
third most common cancer cause of death in men + women

Question 12

Forms of colorectal cancer

Answer 12

sporadic
familial
hereditary syndrome

Question 13

Forms of colorectal cancer

Answer 13

sporadic
familial
hereditary syndrome

Question 14

sporadic form of colorectal cancer

Answer 14

absence of family history
older pop
isolated lesion

Question 15

familial form of colorectal cancer

Answer 15

family history
higher risk index if young
relative is close (1st degree)

Question 16

hereditary form of colorectal cancer

Answer 16

family history
younger age of onset
specific gene defects

Question 17

how does colorectal cancer progress (mechanism)

Answer 17

APC mutation -> COX-2 overexpression (hyperproliferative epithelium) -> K-ras mutation -> p53 mutation -> colon carcinoma

Question 18

risk factors of colorectal cancer

Answer 18

past history - ulcerative colitis/ colorectal cancer etc
family history - 1st degree relative
diet/ environmental - smoking/ obesity/ SES

Question 19

clinical presentation of colorectal cancer

Answer 19

2/3 in descending colon + rectum

1/2 in sigmoid colon + rectum

Question 20

symptoms of colorectal cancer

Answer 20

iron deficiency anaemia (MOST COMMON) - tumours bleeding
Left side/ sigmoid - noticeable bleeding + mucus
Rectal carcinoma - tenesmus/ bleeding + mucus
change of bowel habit - diarrhoea
distal ileum obstruction
palpable mass

Question 21

Late local invasion symptoms of colorectal cancer

Answer 21

bladder symptoms

female genital tract symptoms

Question 22

metastastic symptoms of colorectal cancer

Answer 22

liver - hepatic pain + jaundice
Lung - cough
regional lymph nodes
Peritoneum - Sister Mary Joseph nodule (cancer in the umbilicus)

Question 23

Signs to find on abdominal exam

Answer 23

abdominal mass

tenderness + distension

Question 24

Tests for colorectal cancer

Answer 24

faecal occult blood test - detects minute amounts of blood in faeces
Bloods - anaemia/ tumour markers (CEA) but can be non-specific (if it goes down to 0 during chemo - monitor risk of recurrence)

Question 25

Investigations for colorectal cancer

Answer 25

colonoscopy - under sedation - visualise lesions + remove small polyps CT colonoscopy - can't do colonoscopy + less invasive = identify any lesions MRI - depth of invasion of tumour + choose between chemo or surgery CT CAP - staging prior to treatment

Question 26

How is colorectal cancer managed

Answer 26

Mainly surgery Sometimes stent until chemo/ surgery resection of the primary anastomosis for right + transverse colon Hartmann's procedure for let sided obstruction

Question 27

what is pancreatic cancer

Answer 27

common + v lethal (v late presentation) | commonest form is pancreatic ductal adenocarcinoma

Question 28

pancreatic cancer epidemiology

Answer 28

incidence higher in western countries rare before 45 yrs old incidence + mortality are pretty close = very lethal

Question 29

risk factors for pancreatic cancer

Answer 29

chronic pancreatitis = 18 fold increase risk Type 2 diabetes smoking family history Inherited syndromes (eg. hereditary pancreatitis)

Question 30

pathogenesis of pancreatic cancer

Answer 30

intraepithelial neoplasias (like polyps) - microscopic - get more malignant + pancreatic epithelium mutates into cancerous cells

Question 31

clinical presentation of pancreatic cancer in head

Answer 31

jaundice - invasion/ compression of bile duct (cancer at head of pancreas) weight loss - anorexia/ malabsorption pain - advanced/ if radiates to back = unresectable gastrointestinal bleeding - duodenal invasion

Question 32

presentation of body + tail of pancreas

Answer 32

``` jaundice is uncommon insidious marked weight loss + back pain Vomiting sometimes - invasion of duodeno- jejunal flexure Most unresectable at time of diagnosis ```

Question 33

how to diagnose pancreatic cancer

Answer 33

tumour marker CA19-9 - elevated ultrasonography - identify tumours/ dilated bile ducts/ liver metastasis dual phase CT - predicts resectability

Question 34

how to investigate pancreatic cancer

Answer 34

MRI - predicts resectability MRCP - ductal images without complications of ERCP ERCP - double duct sign/ biliary stunting to relieve jaundice EUS - detection of small tumours before chemo (can't resect)

Question 35

liver cancer types

Answer 35

hepatic cellular cancer (of hepatocytes) cholangiocarcinoma - of bile duct (where hepatic duct diverges) gallbladder cancer - spreads quickly colorectal cancer - liver metastasis

Question 36

primary liver cancer statistics

Answer 36

70/90% have underlying cirrhosis 4-6 months survival without intervention 5-15% suitable for surgery

Question 37

treatment options of liver cancer

Answer 37

TACE - small catheters into blood supply of tumour feed drugs into tumour + cut off blood supply surgical excision

Question 38

gallbladder cancer + treatments

Answer 38

chronic typhoid cancer/ gallstones - underlying causes 5-8 months without intervention surgical excision systemic chemo ineffective

Question 39

cholangiocarcinoma + treatments

Answer 39

ulcerative colitis/ primary sclerosing cholangitis - - underlying causes less than 6 months without intervention surgical excision systemic chemo ineffective but advances with it

Question 40

secondary liver metastasis + treatments

Answer 40

less than a yr without intervention systemic chemo improving as treatment option surgical excision