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GI Cancers Flashcards

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1
Q

What is a carcinoma?

A

Malignancy of the cells that make up the epithelial lining of skin or organs

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2
Q

What is an adenocarinoma?

A

Malignancy of glandular cells in epithelial tissue

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3
Q

What is an adenoma?

A

Benign tumour formed from glandular structures in epithelial tissues

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4
Q

What is the cancer with the highest prevalence in the UK?

A

Breast/prostate

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5
Q

What is the GI cancer with the highest prevalence??

A

Large bowel

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6
Q

What is the GI cancer with the lowest prevalence?

A

Liver

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7
Q

What are some common non specific signs of GI cancer?

A

Abdominal pain
Dysphagia
Weight loss
Blood in stools
Constipation

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8
Q

What GI cancer is likely with this presentation?

55yr old man presents with severe Dysphagia to solids and worsening Dysphagia to liquids. 40 pack yr smoking and a 6 pack of beer per day. Lost over 10% body weight and is currently nourished by milkshakes. Has mild odynophagia and is constantly coughing up mucus.

A

Oesophageal cancer

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9
Q

What is odynophagia?

A

Painful swallowing

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10
Q

What is the most common cause of oesophageal cancer histologically in the upper 2/3s of the Oesophagus?

A

Squamous cell carcinoma

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11
Q

What is the most common cause of Oesophageal cancer of the lower 1/3 histologically?
Oovu java version

A

Sucking dick (everyone’s apart from cal)
Your mum
Dawn Donoher
Smoking
Vomiting from Cals sperm eww
Cals sperm tastes like vomit
Its putrid
Smell all funky go get checked
Being daisy
Pots
Cups
Plates
Cals stupid attitude
Fuck cal
Stupid ass hoe
Imagine being ugly

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12
Q

What is the most common cause of Oesophageal cancer of the lower 1/3 histologically?

A

Adenocarinomas from columnar epithelia

Barretts oesophagus

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13
Q

What are the clinical signs of Oesophageal cancer?

A

Progressive Dysphagia

Initially solids more difficult t swallow than fluids, eventually hard to swallow liquids

Odynophagia
Unexplained weight loss

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14
Q

What is the main red flag symptom for oesophageal cancer?

A

Progressive Dysphagia

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15
Q

What is the acronym used to remember red flags for oesophageal cancer?

A

ALARM

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16
Q

What are the red flag symptoms for oesophageal cancer?

A

ALARM

Anaemia (GI cancers often ulcerate)
Loss of weight
Anorexia
Recent onset of progressive symptoms
Malaena or masses

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17
Q

What is malaena?

A

Black tarry stool due to an upper GI bleed

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18
Q

What are the risk factors of oesophageal cancer?

A

SCC = smoking, alcohol use and dietary (hot beverages)

Adenocarnioma = obesity, reflux disease, Barretts oesophagus

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19
Q

What is the prognosis of survival after being diagnosed with oesophageal cancer?

A

5% survival at 5yrs

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20
Q

What investigations should be done if suspecting oesophageal cancer?

A

FBC (Anaemia)
Oesophagogastroduodenoscopy with biopsy

CT thorax and abdomen to stage

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21
Q

What treatment is done for oesophageal cancer?

A

Endoscopic therapies (for early stage)
Oesphagectomy (removal of oesophagus
Chemoradiotherapy

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22
Q

What type of cancer is this patient likely to have?

77yr old
Weight loss of 6.8kg and 3month of Dysphagia and abdominal pain
Stools positive for occult blood

A

Gastric cancer

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23
Q

What is occult blood?

A

Blood that is not visible to the naked eye in the stool

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24
Q

What is the most common cause of gastric cancer histologically?

A

Adenocarcinomas

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25
What are the most common locations for adenocarcinomas in gastric cancer to occur?
Cardia Antrum Body of stomach
26
How does gastric cancer of the cardia present?
Similar to oesophageal cancer (Dysphagia)
27
How does non cardia Gastric cancer present?
Vomiting due to cancer restricting the stomach contents entering the duodenum
28
What is the Lauren classification for gastric cancers??
Diffuse = poorly differentiated Intestinal = better differentiation so has better prognosis
29
What are some strong risks of developing gastric cancer?
Pernicious anemia H-pylori N-nitroso compounds
30
How does pernicious anemia increase risk of gastric cancer?
Immune response to parietal cells leading to les intrinsic factor being produced
31
What foods are high n-nitroso compounds?
Processed foods
32
What are the most common signs or symptoms for developing gastric cancer?
Weight loss Epigastric abdominal pain Lymphadenopathy of VIRCHOWS node Dysphagia (if located around the cardia)
33
Where is VIRCHOWS node located?
Left supraclavicular fossa
34
What is the prognosis for gastric cancer with local disease and metastasis?
Local = 70% 5 year survival Metastasis = 5%
35
What investigations are done for gastric cancer?
Bloods (anaemia) Upper GI endoscopy and biopsy for diagnosis CT (Chest, abdomen and pelvis) for staging
36
How is Gastric cancer managed?
Superficial gastric caner = endoscopic mucosal resection Localised = gastrectomy or Chemo Advanced/metastatic = chemotherapy/immunotherapy and supportive care
37
What GI cancer is this patient likely to have? 45yr woman Vague Epigastric pain Treatment PPI, analgesia and antacids ineffective Experiencing back pain Pancreatic mass with liver metastases
Pancreatic cancer
38
What is the main histological type of pancreatic cancer?
Pancreatic duct all (exocrine) adenocarinoma
39
What is special about pancreatic neuroendocrine tumours?
Can be functional so can produce hormones like insulin (insulinoma)
40
What are the risk factors for pancreatic cancer?
Smoking Chronic pancreatitis Inherited mutations in BRCA1, BRCA2 and PALB2 and familial syndromes Men Old
41
What are the risk factors for pancreatic cancer?
Smoking Chronic pancreatitis Inherited mutations in BRCA1, BRCA2 and PALB2 and familial syndromes Men Old
42
What are the red flag presentations of pancreatic cancer?
Painless jaundice Unexplained weight loss Can present with abdominal/back pain New onset type 2 DM in someone over 50 without any obesity related risk factors
43
When does painless jaundice occur with pancreatic cancer?
The tumour needs to grow at the head of the pancreas to block the bile duct
44
What investigations are done if pancreatic cancer is suspected?
Bloods (LFT if jaundice, CA 19-9) CT Ultrasound for (head of pancreas cancer, not very accurate for body or tail) Biopsy
45
What is the tumour marker for Pancreatic cancer?
CA 19-9
46
What is the management for pancreatic cancer?
Surgical resection (needs insulin therapy and pancreatic enzyme replacement) Biliary stenting if jaundiced Chemo, radio and symptom management
47
What is hepatocellular carcinoma
Where the primary cancer arises from hepatocytes (Usually with a background of cirrhosis)
48
What are the risk factors of hepatocellular carcinoma?
Cirrhosis (Often due to alcohol and Hepatitis B and C infections)
49
What is the clinical presentation for hepatocellular carcinoma?
Worsened ascites and fatigue (since most HCC occurs in patients with liver disease like cirrhosis) Painful palpation of RUQ
50
What is the prognosis for hepatocellular carcinoma with completed surgical resection or liver transplant? Advanced HCC?
50% 5 year survival with complete resection Advanced = 1yr median survival
51
What investigations are done on a patient with suspected hepatocellular carcinoma?
Bloods: -LFTs -Prothrobin time/INR (check synthetic liver function) -viral hepatitis panel Ultrasound (can screen high risk individuals) CT/MRI abdomen (staging) Liver biopsy
52
What is the treatments for hepatocellular carcinoma?
Resection, transplantation or ablation (using very hot or cold to remove tumour) Chemo/immunotherapy if surgery not suitable
53
Why are liver cancers most commonly metastases and not the primary site?
Many structures drain into the liver via the portal vein (haematological spread) Lymphatic spread Ovarian cancer can spread via transcoelomic spread
54
How can ovarian cancer metastasise too the liver?
Fimbriae open to peritoneal cavity so can spread transcoelomically to the liver
55
What are the 3 main veins forming the portal vein?
Splenic vein Superior mesenteric vein Inferior mesenteric vein
56
What is a cholangiocarnioma?
Cancer of the bile duct
57
What are most of chloangiocarinomas histologically?
Adenocarcinoma
58
What is meant by a cholangiocarcinoma being intrahepatic or extrahepatic?
Intrahepatic = bile ducts in liver Extrahepatic = bile duct outside liver
59
What are the risk factors for development of chlangiocarcinoma?
Liver and bileduct disease: -cirrhosis -alcoholic liver disease -gallstones -Primary Sclerosing Cholangitis Infections High alchol consumption Exposures to certain toxins/meds
60
What are the red flag clinical signs for cholangiocarinoma?
PAINLESS JAUNDICE (Obstruction of biliary system) Pruritus Dark urine and light colour stool in extrahepatic due to biliary obstruction
61
Why is urine dark and stool light if the biliary tree is obstructed?
Liver still able to conjugated bilirubin This makes it water soluble So lots of conjugated bilirubin gets absorbed back into the blood Since the conjugated bilirubin is water soluble it can be filtered by the kidney lots of conjugate bilirubin ends up in the urine which makes it dark
62
What is the prognosis for cholangiocarcinoma?
2% survival over 5yrs with metastatic disease
63
How is cholangiocarcinoma treated?
Surgical and non surgical
64
How do colorectal cancers often present histologically?
Adenocarcinomas which have progressed/developed from normal epithelium in a classical pattern
65
What are the risk factors for colorectal cancer?
Diet: -high fat -red meat consumption -low fibre -high alcohol intake IBD (chronic inflammation inc cancer risk) Genetic conditions: -Familial adenomatous polyposis (FAP) -Hereditary nonpolyposis colorectal cancer (HNPCC)
66
What is the alternate name for hereditary nonpolyposis colorectal cancer (HNPCC)?
Lynch syndrome
67
What are the red flag clinical presentations for colorectal cancer?
Blood in stool Altered bowel habits Bowel obstruction Perforation or symptoms due to hepatic or peritoneala metastases
68
What is the prognosis for colorectal cancer?
5yr survival rate for non metastatic = 50% - 95%
69
What are the red flag symptoms/signs for colorectal cancer?
Blood in stool/rectal bleeding Change in bowel habit Iron deficiency anaemia Unexplained weight loss Tenesmus Mass on rectal exam Alternating constipation + watery diarrhoea
70
What is tenesmus?
Still the urge to go to the toilet after clearing bowels
71
Why is it important to determine what type of blood is in the stool?
Fresh red blood (on tissue) = likely anal fissure or haemorrhage Blood mixed in stool = cancer/pathology more proximal in rectum Malaena = Upper GI tract bleed
72
What can cause overflow diarrhoea in colorectal cancer?
Solid stool stuck behind Tumor Liquid stool builds up behind the tumour Pressure builds up high enough till the watery stool is pushed through
73
What is considered right sided colon cancer?
Ascending colon
74
What is considered left sided colon cancer?
Descending and sigmoid colon
75
What is the difference in type of bleeding in colorectal cancer that is right sided or left sided?
Right sided = occult bleeding Left sided = rectal bleeding
76
What is occult bleeding? Why is it more commonly seen in right sided colon cancer and not left?
When blood in the stool is not visible to the naked eye Since the blood has more time to be processed
77
Why is the bowel more likely to be obstructed in right sided colon cancer than left?
The ascending colon has a narrower lumen than the descending and sigmoid colon
78
Where is a mass palpable in right sided colon cancer and left sided colon cancer?
Right = right iliac fossa Left = left iliac fossa
79
How do the types of lesions differ in right sided and left sided colorectal cancer?
Right sided = fungating lesions Left sided = stenosing lesions
80
What is meant by a fungating lesion?
Lesion that causes ulceration
81
What is meant by a stenosing lesion?
Leads to fibrosis and stricture formation
82
Look at the last slide at image 1: What is the sign called? What is it indicative of?
Apple core sign Colorectal tumour narrowing bowel
83
What is the change in cell type that occurs in the adeno-Carcinoma sequence for colorectal cancer?
Normal glandular epithelium -> adenoma (benign neoplasm) -> invasive carcinoma
84
What genes are turned off and on in the series of genetic mutations that cause the adenoma-carcinoma sequence?
Oncogenes activated Tumour suppressor genes inactivated
85
What is an example of a Tumour suppressor gene?
p53
86
What investigations are done for colorectal cancer?
Stool test (recall immunochemical test) Bloods (anemia CEA) Colonoscopy CT, MRI
87
What is the tumour marker for colorectal cancer?
CEA
88
How is colorectal cancer managed?
Surgery with pre or post op chemo/immunotherapy Chemo/immunotherapy if not for surgery
89
What age is bowel cancer screening done between?
60-74 Testing for blood in faeces
90
What is the main histological cause of anal cancer?
Squamous cell carcinoma
91
What are the risk factors for developing anal cancer?
HPV infection HPV-16 HIV infection Anal receptive intercourse (inc risk of HPV) Chronically local inflammation due to IBD or recurrent anal fissures
92
How does anal cancer present?
Perianal Pruritus Perianal pain Bleeding Discharge Mass like sensation
93
What is the prognosis for anal cancer?
70% cured with chemo HPV smears and better prevention of HIV infection will lower incidence
94
How are GI cancers staged?
TNM staging T = primary Tumor size N = extent of regional ymph node involvement M = metastatic spread Then converted to overall stage 1,2,3,4 4 = worst
95
What is Dukes staging system?
Staging of colorectal cancer
96
How is colorectal cancer staged using dukes staging system?
A = confined in bowel wall B= through mucosal wall C = spread to a lymph node D = metastasised to another organ
97
Go to the last slide: What pathology is visible?
Barrett’s oesophagus

Y2 - GI (35 decks)

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