GI Cancers Flashcards
(24 cards)
Anal cancer is most commonly what histological type, and associated with which infection?
Anal cancer is an epidermoid or squamous cell tumour that is almost always associated with HPV
Treated with combined chemoRTx (surgery not indicated)
How do you monitor patients after treatment of CRC?
Physical exam & serum CEA level - 3-6/12 for first 3 years, then 6/12 after
AND
CT CAP - annually for first 3 years post op
AND
Colonoscopy - 1 year after resection, then 3 years later, then every 5 years
What are the risk factors for pancreatic cancer?
Chronic pancreatitis (gallstones & ETOH)
Tobacco use/smoking
Genetics/FHx in 5-10%
- BRCA2 gene mutation
- HNPCC
- Familial pancreatic cancer
Intrapancreatic mucinous neoplasia (IPMN)
What is the management of pancreatic cancer?
Surgical resection (whipple’s procedure) if possible
+
Adjuvant chemotherapy
OR FOR METASTATIC DISEASE
1st line: Gemcitabine +/- Cisplatin or Oxaliplatin (combination therapy increases response rate, with no additional survival benefit and toxicity++)
What are the risk factors for oesophageal cancer?
Risk factors: GORD Barrett's oesophagus* Tobacco use Alcohol Lower socioeconomic status Obesity
What are the risk factors for gastric cancer?
H. Pylori (main risk factor) Tobacco use EBV Genetics/FHx - BRCA 2, HNPCC, Peutz-Jegher syndrome - Familial diffuse gastric cancer, due to CDH-1 (100% risk of diffuse gastric cancer and lobular breast cancer)
What are the classic features of carcinoid syndrome?
Diarrhoea, facial flushing, wheeze, facial telangiectasia, tachycardia
Most NETs (>50%) are hormonally non-functional, but 25% secrete a functional hormone - most commonly this hormone is serotonin which causes the classic carcinoid syndrome. Carcinoid syndrome can only occur once the tumour is no longer confined to the SI or mesentery.
It occurs in
What are the most common sites of carcinoid tumours?
Appendix 35% (most common) Ileum 28% Rectum 13% Bronchus 13% Other
What is the treatment of neuroendocrine tumours (NETs)?
Indolent nature, allows for observation only
If somatostatin receptor positive and hormonally active (causing carcinoid syndrome) -> Octreotide/Lanteotide (synthetic somatostatin analogue)
Chemotherapy is minimally active against NETs
Resect hepatic mets where possible
What is the significance of CEA level post-surgical resection for CRC?
Elevation of CEA level post resection indicates probable incomplete excision.
However, return of CEA to normal does NOT correlate with complete excision of disease, and disease may persist despite normalisation of previously elevated CEA
What percentage of patients with pancreatic cancer have metastatic disease at diagnosis?
What is the overall survival rate of patients with pancreatic cancer at 1 and 5 years?
At diagnosis:
- 50% have metastatic disease
- 30% have locally advanced disease
- 20% have operable disease
Overall survival is 24% at 1 year; 5% at 5 years
What is the mortality rate from a Whipple’s procedure (pancreatoduodenectomy), and what are some complications from this procedure?
1-2% mortality rate from Whipple’s procedure
Complications:
- anastomotic/bile leak
- malabsorption
- brittle diabetes
- pancreatitis
- failure to thrive
Hepatocellular carcinoma may be treated in a number of ways, including transplant, resection, TACE, DC beads, radiofrequency ablation or ETOH. What is the only systemic treatment available for HCC?
Sorafenib = a multi-targeted kinase inhibitor with some activity against fibroblast growth factors (thus also improves cirrhosis)
- improves overall survival
Sorafenib is the only systemic therapy available for the treatment of HCC. What are some of the toxicities associated with Sorafenib?
Fatigue Hypertension Diarrhoea Skin toxicity - Hand-foot syndrome (HRS) in 40% - Non-HFS skin toxicities (bleeding, alopecia, pruritis, skin rash, stomatitis, xerosis)
What are the predominant histological types of oesophageal cancer?
Adenocarcinoma is the predominant histological type, but epidermoid and squamous cell remain common in Asia and Africa
In the upper 2/3 oesophagus = Squamous
In the lower 1/3 oesophagus = Adenocarcinoma
What is the best test to stage gastric and pancreatic NETs?
Gallium DOTATATE PET scans (or octreotide scintigraphy)
- Used to assess somatostatin (SSA) receptor density
- Changes management in 20-30%
What is the management of carcinoid syndrome?
Symptomatic: Loperamide (for diarrhoea) Steroids H1 & H2 blockers Chlorpromezine (for flushes)
Long acting somatostatin analogue (SSA)
TTE every 6-12/12
Debulking surgery for primary tumour
Peptide receptor radionucleotide therapy (PRRT):
- i.e. Octreotide (in DOTATATE uptake positive disease)
Other than colorectal cancer, what other cancers is FAP associated with?
CRC - almost 100% Desmoid tumour - 10-20% Small bowel - 4-12% Biliary/pancreatic - 2% Thyroid/adrenal Brain
In what gene is the underlying mutation in Familial Adenomatous Polyposis (FAP)? Is this autosomal dominant or recessive?
Autosomal dominant
Mutation is in the adenomatous polyposis coli (APC) gene, which results in >100 adenomatous polyps from mid-teens
What are the mismatch repair genes implicated in HNPCC (Lynch syndrome)? Are these autosomal dominant or recessive?
Autosomal dominant
Mutations are in:
- MLH 1
- MSH 2
- MSH 6
- PMS 2
- EPCAM
Lynch syndrome accounts for 3-5% of all CRC
HNPCC (Lynch sydnrome) increases your risk of multiple cancers, including CRC. What other cancers are associated with Lynch syndrome?
CRC - 80% Endometrial - 20-60% Stomach - 10-20% Ovarian - 9-12% Hepatobiliary - 2-7% Urinary tract - 4-5% Small bowel - 1-4% Brain - 1-3%
What is Gardner syndrome?
FAP with extra-intestinal features of osteomas, desmoid tumours and/or epidermoid cysts
What is Turcot syndrome?
Familial colon cancer with a primary brain tumour
i. e. medulloblastoma in FAP
i. e. GBM in Lynch syndrome
What is ‘desmoid disease’ in patients with familial adenomatous polyposis (FAP)?
Desmoid disease is characterised by aggressive growths of fibrous tissue in 10-30% of those with FAP
- growths are often intra-abdominal causing pain, SBO, fistulas and GI bleeding
- multiple ++
- desmoid tumours recur after resection
Avoid and delay surgery in these patients as desmoid tumours will regrow and surgery may cause pouches in desmoid-prone patients
Manage with observation, NSAIDs (Sulindac), anti-oestrogens and surgery (last resort)
