Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 2 Gastro > GI Cancers > Flashcards

GI Cancers Flashcards

(76 cards)

Start Studying
1
Q

Define Cancer

A

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is primary cancer?

A

Arising directly from the cells in an organ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is secondary cancer?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the first 6 hallmarks of cancer?

A 
Sustaining proliferative signalling
Evading growth suppressors
Activating invasion and metastasis
Enabling replicative immortality
Evading angiogenesis
Resisting cell death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the emerging hallmarks of cancer?

A

Deregulating cellular energetics

Genome instability and mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the enabling characteristics of cancers?

A

What gives them selective advantage

  • Genome instability and mutation
    Tumor promoting inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the instant truths re. cancer?

A

Cancer is a genetic disease
Cancers contain multiple genetic errors
Cancers contain more than just malignant cells
Killing cancer cells is easy
ONLY killing cancer cells is very hard
Developing novel therapies for cancer fraught with problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is cancer of the glandular epithelium of the GI tract?

A

Squamous cell carcinoma

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is cancer of the neuroendocrine cells of the GI tract?

A

Neuroendocrine tumours

Gastrointestinal stromal tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is cancer of the connective tissue of the GI tract?

A

Leiomyoma/Leiomyosarcomas

Liposarcomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the connective tissues present in the GI tract?

A

Smooth muscle

Adipose tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most common GI cancer?

A

Bowel (4th most common)

2nd highest morbidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why are GI cancers problematic?

A

Low incidence but high death rates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is essential for lessening cancer morbidity?

A

Cancer screening - catching the disease early

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is cancer screening?

A

Testing of asymptomatic individuals to identify cancer at an early stage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do we identify whether a disease is suitable for screening?

A

Wilson & Jungner criteria.

Depends on the epidemiology of a disease & features of the test.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the Wilson and Jungner criteria?

A

The condition should be an important health problem

There should be an accepted treatment for patients with disease

Facilities for diagnosis and treatment should be available

There should be a recognisable latent or early symptomatic stage

There should be a suitable test or examination

The test should be acceptable to the population

The natural history of the condition, including development from latent to declared disease should be adequately understood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is colorectal screened for?

A

Offered to healthy individuals:

Faecal immunochemical test (FIT) - detects haemoglobin in faeces, every 2 years for everyone aged 60-74

One-off sigmoidoscopy for everyone aged >55 to remove polyps (reducing future risk of cancer).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is oesophageal cancer screened for (screening program)?

A

Regular endoscopy to patients with:

Barrett’s oesophagus
Low- or high-grade dysplasia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Are pancreatic and gastric cancers screened for?

A

No test exists that meets the W & J criteria.

Depends on incidence - Japan screens for gastric cancer (high incidence): perform endoscopies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is hepatocellular cancer screened for?

A

Regular ultrasound & AFP for high-risk individuals with cirrhosis
Viral hepatitis
Alcoholic hepatitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Who else is offered screening?

A

Those with genetic predisposition or strong family histories

e.g. FAP - multiple polyps in colon and duodenum, offered prophylactic resections and yearly colonoscopies or OGD’s

OR

Hereditary pancreatitis - 40% lifetime risk of pancreatic cancer, offered prophylactic surgery and yearly imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the cancer journey?

A

Diagnosis
Staging
Treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the first step in the pathway involving the Cancer MDT?

A

Initial presentation e.g. worrying symptoms to GP or A&E doctor

OR

The patient is identified through a screening programme (e.g. faecal occult blood test for colon cancer).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the second step in the pathway involving the Cancer MDT?
The patient is referred through the 2-week-wait cancer pathway
26
What is the third step in the pathway involving the Cancer MDT?
Diagnostic tests
27
What is the fourth step in the pathway involving the Cancer MDT?
MDT
28
What is the fifth step in the pathway involving the Cancer MDT?
Treatment
29
Who is in the cancer MDT?
``` Pathologist Radiologist Palliative care Gastroenterologist Oncologist Surgeon Cancer nurse specialist ```
30
What is the role of the pathologist?
Confirms the diagnosis of cancer using biopsy samples. Provide histologic typing Provide molecular typing Provides the tumour grade
31
How is histologic typing done?
i.e. what type of cell does the cancer come from? Epithelium (squamous cell carcinoma) or secretory cells (adenocarcinoma). Non-epithelial cells less common in the GI tract. Neuroendocrine tumours (pancreas) Gastrointestinal stromal tumours (GISTS) – (stomach)
32
What is molecular typing?
what mutations does this cancer have? | Alongside the histological type, this can determine types of treatment available.
33
What does the grade mean?
how aggressive is the cancer? | Determined by how ‘abnormal’ cells & their nuclei are and how actively they are dividing.
34
What does the radiologist do?
Reviews scans If diagnosis is unclear, comments on how likely the scan is to confirm cancer. Suggests other imaging to clarify suspected diagnosis Should a biopsy be performed and from where? Provides radiological tumour stage Provides re-staging after treament Interventional radiology
35
What is staging?
how far has the cancer spread? The TNM system used. T - size of Tumour. N - lymph Node involvement M - presence of distant Metastases. A T2N0M0 tumour may be totally curable, but a T3N1M1 may not be.
36
What is asked in re-staging?
Has it remained stable or progressed? | Did the cancer respond completely or partially?
37
What is the role of interventional radiology?
Percutaneous biopsies | Radiological stents
38
What does the surgeon do?
Decides whether surgery is appropriate. Is the tumour resectable? Is the patient fit enough for surgery? Performs operation & cares for patient in perioperative period
39
What does the gastroenterologist do?
Endoscopy – diagnostic & therapeutic Upper GI Oesophageal & gastric biopsies Oesophageal stents Liver & pancreas ERCP & EUS biopsies Biliary stents Lower GI Colonic biopsies Colonic stents
40
What do oncologists do?
Decides on whether chemotherapy, radiotherapy or other systemic therapy is appropriate. Coordinates the overall treatment plan
41
What is considered by the oncologist?
scans, histological and molecular type. | Is the patient fit for full intensity therapy?
42
What choices are made when coordinating on treatment plan?
Should chemotherapy come before surgery (neoadjuvant) or after (adjuvant)? Takes into consideration Type, grade & stage Patient fitness (‘performance status’) and wishes.
43
What do the MDT decide with regards to treatment plan?
MDT decides whether plan should be for radical (curative) or palliative therapy or palliative care Palliative care CNS (Cancer Nurse specialist)
44
What is the major driver of gastric adenocarcinoma?
Chronic gastritis is the major driver
45
What causes gastric adenocarcinoma?
H.pylori infection due to chronic acid overproduction Pernicious anaemia autoantibodies against parts & products of parietal cells ``` Partial gastrectomy (e.g. for an ulcer) leading to bile reflux ``` Epstein-Barr virus infection Family history (including heritable diffuse-type gastric cancer due to E-cadherin mutations) High salt diet & smoking
46
What are the stages of gastric cancer progression (process)?
Chronic gastritis Intestinal metaplasia dysplasia malignancy
47
What is the most common symptom of gastric cancer?
Dyspepsia (upper abdominal discomfort after eating or drinking)
48
What are the red flags for gastric cancer?
``` ALARMS55 Anaemia Loss of weight or appetite Abdominal mass on examination Recent onset of progressive symptoms Melaena or haematemesis Swallowing difficulty 55 years of age or above ```
49
How is gastric cancer diagnosed?
endoscopy + biopsy
50
How is gastric cancer staged (procedures)?
CT of the chest, abdomen & pelvis will provide information on distant lesions PET-CT Diagnostic laparoscopy - peritoneal & liver metastases disease prior to full operation Endoscopic ultrasound - will give most detail about local invasion & node involvement
51
What are the treatment options for gastric cancer?
Neoadjuvant chemotherapy Oesophago-gastrectomy Total gastrectomy Subtotal gastrectomy Adjuvant chemotherapy
52
What can neoadjuvant chemotherapy be used for?
Reducing the size of the tumour before surgery
53
What are the main features of Neuroendocrine tumours?
Arise from the gastroenteropancreatic (GEP) tract (or bronchopulmonary system) Diverse group of tumours Regarded as common entity as arise from secretory cells of the neuroendocrine system
54
What causes NETs?
Sporadic tumours in 75% Associated with a genetic syndrome in 25% Multiple Endocrine Neoplasia Type 1 (MEN1)  Parathyroid tumours Pancreatic tumours Pituitary tumours 
55
How NETs present?
Most NETs are asymptomatic & incidental findings Secretion of hormones & their metabolites in 40% serotonin, tachykinins (substance P) & other vasoactive peptides < 10% of NETs produce symptoms
56
What are the consequences of NETs (symptoms)?
``` Carcinoid syndrome: Vasodilatation Bronchoconstriction ↑ed intestinal motility Endocardial fibrosis (PR & TR) = right sided heart problems Flushing of face ```
57
What is carcinoid syndrome?
Tumour secretes excess of Serotonin directly into system circulation
58
What is the most common NETs?
Insulinoma Hypoglycaemia Whipple's triad (symptoms of hypoglycaemia, proven to have low plasma glucose at time of symptoms, symptoms relived on eating)
59
What are the clinical features of glucagonoma?
Diabetes mellitus, necrolytic migratory erythema (red, blistering rash - mouth and extremities) Alpha cells
60
What are the clinical features of gastrinomas?
Zollinger-Ellison syndrome Too much gastrin Peptic ulcers Abdominal pain and diarrhoea
61
What are the clinical features of VIPomas?
Verner-Morrison syndrome, watery diarrhoea | vasoactive intestinal peptide
62
What are the clinical features of somatostatinomas?
Gallstones, diabetes mellitus, steatorrhoea | D-cells
63
What are the clinical features of midgut NETs?
Most are non-functioning, 40% develop carcinoid syndrome
64
What are the clinical features of hindgut NETs?
Most are non-functioning
65
How do you diagnose NETs?
When suspected, investigations to localise the tumour & confirm the diagnosis with histology Biochemical Assessment Imaging
66
What comprises the biochemical assessment of NETs?
Chromogranin A is a secretory product of NETs Other gut hormones: insulin, gastrin, somatostatin, PPY Measured in fasting state Other screening: Calcium, PTH, prolactin, GH 24 hr urinary 5-HIAA (serotonin metabolite)
67
What type of imaging is looked at for NETs?
Cross-sectional imaging (CT and/or MRI) Bowel imaging (endoscopy, barium follow through, capsule endoscopy) Endoscopic ultrasound Somatostatin receptor scintigraphy IV radiolabled 68Ga-DOTATATE PET/CT most sensitive
68
How to we grade GEP-NETs?
Grade (1-3) Mitoses Ki-67 index
69
What are the treatment modalities for NETs?
Curative resection (R0) Cytoreductive resection (R1/R2) Liver transplantation (OLTx) RFA, microwave ablation Embolisation (TAE), chemoembolisation (TACE) Selective Internal RadioTherapy (SIRT) 90Y-Microspheres (radiolabel somatostatin) Somatostatin receptor radionucleotide therapy 90Y-DOTA 177 Lu-DOTA Medical therapy, targeted therapy, biotherapy Octreotide, Lanreotide, SOM203 PK-inhibitors, mTOR-inhibitors ⍺-Interferon
70
What is TAE and TACE?
Transarterial (chemo) embolisation
71
What are the causes of microcytic anaemia?
1. Iron deficiency anaemia 2. Anaemia of chronic disease 3. Thalassaemia 4. Sideroblastic anaemia
72
What are the causes of normocytic anaemia?
``` ABCDE Aplastic anaemia Bleeding Chronic disease Destruction (haemolysis) Endocrine disorders - Hypothyroidism - Hypoadrenalism ```
73
What are the causes of macroocytic anaemia?
FAT RBC: Foetus (pregnancy) Alcohol excess Thyroid disorders Reticulocytosis B12/Folate deficiency Cirrhosis
74
What are the GI causes of IDA?
1. Aspirin/NSAID use 2. Colonic adenocarcinoma 3. Gastric carcinoma 4. Benign gastric ulcer 5. Angiodysplasia 6. Coeliac disease 7. Gastrectomy (decreased absorption) 8. H.pylori
75
What are the non GI causes of IDA?
1. Menstruation 2. Blood donation 3. Haematuria (1% of iron deficiency anaemias) 4. Epistaxis
76
What is the organised structure for investigations?
``` Bedside tests Blood tests Imaging Microbiology Special/Invasive ```

Year 2 Gastro (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions