GI - Cancers

Question 1

Barrett’s oesophagus is associated with an increased risk of what form of oesophageal cancer?

Answer 1

Adenocarcinoma

Question 2

The upper 2/3rds of the oesophagus are more likely to have what form of cancer?

Answer 2

Squamous cell carcinoma

Question 3

What are signet rings a sign of?

Answer 3

Gastric cancer

Question 4

What part of the stomach is most commonly the site of cancer?

Answer 4

The cardia

Question 5

What are some symptoms of oesophageal carcinomas?

Answer 5

Progressive dysphagia
GORD symptoms
Nausea
Loss of appetite
Hoarse voice
Haematemesis
Weight loss

Question 6

What are some of the risk factors for developing oesophageal-gastric carcinomas?

Answer 6

GORD
Barrett's oesophagus
Alcohol excess
Smoking
Asian ethnicity
H pylori
pernicious anaemia
Group A blood type
Gastric adenomatous polyps

Question 7

What is the most common type of gastric cancer?

Answer 7

Adenocarcinoma

Question 8

List some signs / symptoms of gastric cancer?

Answer 8

Anorexia
Dyspepsia
Dysphagia
Epigastric pain
Virchow's node (left supraclavicular fossa)
Anaemia

Question 9

How is gastric cancer investigated?

Answer 9

An FBC may reveal anaemia
OGD and biopsy
CT/MRI to stage the disease

Question 10

What are the main sites of metastasis in gastric cancer?

Answer 10

Liver (48%)
Peritoneum
Bone
Lung 
Nervous system (seen in cardia cancers)

Question 11

In gastric cancer when might a subtotal gastrectomy be appropriate?

Answer 11

(Proximally sited disease) When the tumour is 5-10 cm away from the gastroesophageal junction

Question 12

When would a total gastrectomy be more suitable in gastric carcinomas?

Answer 12

When the tumour is <5 cm from the gastroesophageal junction

Question 13

What is a common metabolic side effect of a gastrectomy?

Answer 13

Dumping syndrome

Question 14

What are some of the symptoms of dumping syndrome?

Answer 14

Early: Sweating and fainting after a meal caused by sudden dumping of food in jejunum
Late: Rebound hypoglycemia caused by a surge of insulin in response to dumping of food into intestine

Question 15

What hereditary syndrome is associated with duodenal and gastric fundic polyps as well as abdominal desmoid tumours?

Answer 15

Familial adenomatous polyposis

Question 16

What are the tumour markers associated with familial adenomatous polyposis?

Answer 16

APC gene
(80% dominant)

Question 17

How is FAP screened for?

Answer 17

Yearly flexible sigmoidoscopy from age 15. If no polyps by 20 then 5 yearly colonoscopy
All polyps found must be resected

Question 18

What is the risk of polyps becoming malignant in FAP?

Answer 18

100%

Question 19

What disease is associated with a mutation of the PTEN gene on the chromosome 10q22?

Answer 19

Cowden’s disease

Question 20

What type of cancers are associated with cowden’s disease?

Answer 20

Intestinal hamartomas
Multiple trichilemmomas
89% risk of cancer at any site
16% risk of colorectal cancer

Question 21

What non cancerous health condition is associated with Cowden’s disease?

Answer 21

Macrocephaly

Question 22

What type of tumours are associated with Petz-Jeugar’s syndrome?

Answer 22

Benign intestinal hamartomas
Increased risk of GI cancers including colorectal and gastric
Also an increased risk of breast ovarian cervical pancreatic and testicular cancers

Question 23

Peutz Jeghers is associated with what chromosome?

Answer 23

19

Question 24

What is the mutation associated with Peutz-Jeghers syndrome?

Answer 24

STK11

Question 25

What is a symptoms associated with Peutz-Jeghers syndrome?

Answer 25

Increased pigmentation

Question 26

What syndrome is likely to cause right sided, mucinous, colonic cancers?

Answer 26

HNPCC (Lynch syndrome)

Question 27

What other carcinomas are associated with HNPCC?

Answer 27

Gastric | Endometrial

Question 28

How is HNPCC monitored?

Answer 28

Colonoscopy every 1-2 years from age 25 Consider prophylactic surgery Increased colonic surveillance may be required

Question 29

What non colonic cancers are associated with Cowden's disease?

Answer 29

Breast (81%) Thyroid Uterine

Question 30

Where are tumours more likely to occur in the colon of someone with MYH associated plyposis?

Answer 30

Right hand side

Question 31

How is MYH associated polyposis managed?

Answer 31

As soon as it is identified there is a resection and ileoanal pouch reconstruction is the best surgical management. Regular colonoscopy recommended

Question 32

What is common tumour marker for colonic cancer?

Answer 32

CEA

Question 33

What is tumour marker associated with gastric cancer, as well as SCLC and neuroblastomas?

Answer 33

Bombastin

Question 34

CA-19-9 is a common tumour marker associated with what?

Answer 34

Pancreatic cancer

Question 35

What tumour marker is raised in hepatocellular carcinoma?

Answer 35

AFP

Question 36

What form of cancer is the 2nd most common cause of cancer related deaths in the UK?

Answer 36

Colonic carcinomas

Question 37

How is colonic cancer staged?

Answer 37

Modified Duke's criteria | Staged A-D

Question 38

Where are the majority of colonic cancers located?

Answer 38

Sigmoid and rectum

Question 39

What are some signs/symptoms of disseminated malignancy?

Answer 39

Hepatomegaly Jaundice Lymphadenopathy Obstruction

Question 40

What are some symptoms of colon malignancy?

Answer 40

``` PR bleeding Change in bowel habits Weight loss Abdominal mass Tenesmus Anaemia ```

Question 41

What would be seen on a FBC of a patient with colonic malignancy?

Answer 41

Decreased Hb | Decreased MCV

Question 42

How is colonic cancer screened for in the UK?

Answer 42

Ages 60-74 will receive the FIT test every two years (In england) In scotland its 50-74 Uses faecal occult blood testing

Question 43

What screening tool for bowel cancer is being used as a once off for people aged 55?

Answer 43

Flexible sigmoidoscopy to look for polyps

Question 44

Can patients self refer for bowel cancer screening?

Answer 44

Yes anyone aged 55-60 can do so if they have concerns. Eligible for the flexible sigmoidoscopy

Question 45

What is the most common type of colon cancer?

Answer 45

Adenocarcinoma

Question 46

How is bowel cancer investigated?

Answer 46

Sigmoidoscopy Colonoscopy with biopsy CT scan (Barium enema may be used)

Question 47

How is bowel cancer treated?

Answer 47

Surgical resection is the main - curative option | Chemotherapy can be given adjunct

Question 48

When might it be appropriate to give adjunct radiotherapy in colon cancer

Answer 48

When cancer is in the rectum

Question 49

What medication is thought to be preventative in cancer and why?

Answer 49

Aspirin >75mg Reduces likelihood of polyp growth

Question 50

Ulcerative colitis and PSC lead to an increased risk of what cancer?

Answer 50

Cholangiocarcinoma

Question 51

Painless jaundice must always be treated as ______ until proven otherwise?

Answer 51

Pancreatic cancer

Question 52

What is the most common type of anal cancer?

Answer 52

Squamous cell carcinoma

Question 53

What are the main risk factors for anal cancer?

Answer 53

HPV | Anal sexual intercourse

Question 54

A patient has symptoms of: recurrent peptic ulcer disease, watery diarrhoea and weight loss What is this triad indicating?

Answer 54

Gastrinoma

Question 55

What medication can be given to treat a gastrinoma?

Answer 55

Octreotide - a somatostatin synthetic

Question 56

Why is a somatostatin synthetic used to treat gastrinomas?

Answer 56

Gastrinoma secrete gastrin - somatostatin has an inhibitory effect