GI Cancers

Question 1

What is the 2nd most common cause of cancer death in the UK?

Answer 1

Bowel cancer.

Question 2

How many new cases of bowel cancer are diagnosed annually?

Answer 2

Over 42,000.

Question 3

What percentage of bowel cancer cases are diagnosed at a late stage?

Answer 3

Over 50%.

Question 4

What is the most common epithelial type lining most of the GIT?

Answer 4

Columnar epithelium.

Question 5

What type of cancer are most GIT tumours?

Answer 5

Adenocarcinomas.

Question 6

Where are squamous cell carcinomas typically found in the GIT?

Answer 6

Oesophagus and anus.

Question 7

What are the four major routes of tumour spread in GI cancers?

Answer 7

Local, intramural, nodal, and bloodborne (often to liver or lungs).

Question 8

What are common aetiological factors in GI cancers?

Answer 8

Genetic, dietary, environmental, chemical (smoking, alcohol), and inflammation.

Question 9

What is the mainstay of treatment for GI cancers?

Answer 9

Surgery.

Question 10

What determines survival outcome in GI cancer?

Answer 10

Stage at diagnosis.

Question 11

Why are GI cancers often diagnosed late?

Answer 11

Insidious onset of symptoms.

Question 12

What symptom may suggest a right-sided colorectal cancer?

Answer 12

Silent iron deficiency anaemia.

Question 13

What are common symptom complexes in GI cancer?

Answer 13

Bleeding, pain, altered bowel habits, weight loss, dysphagia.

Question 14

What type of pain does a foregut tumour typically cause?

Answer 14

Epigastric pain.

Question 15

What symptom is characteristic of rectal cancer?

Answer 15

Tenesmus.

Question 16

What are the two main types of oesophageal cancer?

Answer 16

Squamous cell carcinoma and adenocarcinoma.

Question 17

What region of the oesophagus is affected by squamous cell carcinoma?

Answer 17

Middle third.

Question 18

What risk factors are associated with squamous oesophageal cancer?

Answer 18

Alcohol, tobacco, poverty, hot beverages, caustic injury, radiation.

Question 19

What region is affected by oesophageal adenocarcinoma?

Answer 19

Lower third and cardia.

Question 20

What condition is a precursor to oesophageal adenocarcinoma?

Answer 20

Barrett oesophagus.

Question 21

What are key symptoms of oesophageal cancer?

Answer 21

Age 70+, Dysphagia, odynophagia, weight loss, haematemesis.

Question 22

What is the 5-year survival rate for oesophageal cancer?

Answer 22

20% or less.

Question 23

What are the two main types of gastric cancer?

Answer 23

Intestinal type and diffuse infiltrative type.

Question 24

What is a precursor lesion of intestinal-type gastric cancer?

Answer 24

Adenoma.

Question 25

What is the pathogenesis of intestinal-type gastric cancer?

Answer 25

Increased Wnt signalling (↓APC, ↑β-catenin).

Question 26

What is the hallmark histological feature of diffuse-type gastric cancer?

Answer 26

Linitis plastica (leather bottle appearance).

Question 27

What is the key molecular event in diffuse gastric cancer?

Answer 27

Loss of E-cadherin (CDH1).

Question 28

Which region has the highest incidence of gastric cancer?

Answer 28

Eastern Europe and Japan.

Question 29

What are the early symptoms of gastric cancer?

Answer 29

Dyspepsia, nausea, dysphagia.

Question 30

What are the late symptoms of gastric cancer?

Answer 30

Weight loss, early satiety, anaemia, anorexia.

Question 31

What is the 5-year survival rate for gastric cancer?

Answer 31

30% or less.

Question 32

What type of pancreatic cancer is most common?

Answer 32

Infiltrating ductal adenocarcinoma.

Question 33

What is the strongest risk factor for pancreatic cancer?

Answer 33

Smoking.

Question 34

What gene is altered in 90–95% of pancreatic cancers?

Answer 34

KRAS.

Question 35

What tumour suppressor gene is inactivated in 95% of cases?

Answer 35

CDKN2A.

Question 36

What are early symptoms of pancreatic cancer?

Answer 36

Usually silent until advanced; pain is often first.

Question 37

What is Courvoisier’s sign?

Answer 37

Painless jaundice due to bile duct obstruction.

Question 38

What is Trousseau’s sign of malignancy?

Answer 38

Migratory thrombophlebitis.

Question 39

What is the prognosis for pancreatic cancer?

Answer 39

Very poor – <5% 5-year survival.

Question 40

What is the most common GI malignancy?

Answer 40

Colorectal cancer.

Question 41

Where is colorectal cancer more common?

Answer 41

Western countries.

Question 42

What type of lesion does colorectal cancer usually start as?

Answer 42

Benign polyp.

Question 43

What are classic symptoms of colorectal cancer?

Answer 43

Altered bowel habit, pain, bleeding.

Question 44

What lifestyle factors increase colorectal cancer risk?

Answer 44

Low fibre, high fat/refined carbs.

Question 45

What gene pathway is commonly affected in sporadic colorectal cancer?

Answer 45

Wnt pathway (APC, β-catenin).

Question 46

What are familial causes of colorectal cancer?

Answer 46

FAP and HNPCC (Lynch syndrome).

Question 47

What age is colonoscopy screening recommended from?

Answer 47

Over 50 years.

Question 48

What symptom indicates a right-sided colon tumour?

Answer 48

Iron deficiency anaemia.

Question 49

What is Duke’s staging used for?

Answer 49

Staging colorectal cancer.

Question 50

What is the most common site for colorectal cancer metastasis?

Answer 50

Liver.

Question 51

What condition is associated with hundreds of polyps?

Answer 51

Familial adenomatous polyposis (FAP).

Question 52

What is the inheritance pattern of FAP and HNPCC?

Answer 52

Autosomal dominant.

Question 53

What genes are defective in HNPCC (Lynch syndrome)?

Answer 53

DNA mismatch repair genes.

Question 54

What percentage of colonic adenomas progress to cancer?

Answer 54

Minority, but risk increases with size.

Question 55

At what age do neoplastic polyps become common?

Answer 55

>60 years.

Question 56

What is the only curative treatment for GI cancers?

Answer 56

Surgery.

Question 57

What therapies are commonly used with surgery?

Answer 57

Radiotherapy and chemotherapy.

Question 58

What determines the prognosis in colorectal cancer?

Answer 58

Stage at diagnosis.

Question 59

What is the 5-year survival rate for Stage I colorectal cancer?

Answer 59

94%.

Question 60

What is the 5-year survival rate for Stage IV colorectal cancer?

Answer 60

11%.

Question 61

What is the overall 5-year survival rate for colorectal cancer?

Answer 61

50%.

Question 62

What percentage of colorectal cancers are diagnosed by screening programmes?

Answer 62

70%