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GI cancers Flashcards

1
Q

what is 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”

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2
Q

what is primary cancer

A

Arising directly from the cells in an organ

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3
Q

secondary

A

Metastasis

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

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4
Q

The Hallmarks of Cancer

A 
sustained proliferative signalling 
evading apoptosis 
activating invasion and metastisis 
enabling replacative immortality 
inducing angiogenisis 
resisting cell death
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5
Q

what are the emerging hallmarks of cancer

A

deregulating cellular energetics

avoiding immune destrcution

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6
Q

what are enabiling characteristics

A

genome instability and mutation

tumour promoting inflammation

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7
Q

is cancer genetic

A

Cancer is a genetic disease

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8
Q

what cancer do squamous cells undergo

A

Squamous Cell Carcinoma (SCC)

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9
Q

what cancer do glandular epithelium undergo

A

Adenocarcinoma

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10
Q

Enteroendocrine cells

A

Neuroendocrine Tumours (NETs)

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11
Q

Interstitial cells of Cajal

A

Gastrointestinal Stromal Tumours (GISTs)

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12
Q

Smooth muscle

A

Leiomyoma/leiomyosarcomas

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13
Q

Adipose tissue

A

Liposarcomas

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14
Q

what is cancer screening

A

Testing of asymptomatic individuals to identify cancer at an early stage

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15
Q

what is the Wilson & Jungner criteria for screening

A

1) condition sought should be important
2) accepted treatment for patients with recognised disease
3) facilities for diagnosis and treatment should be made available
4) recognisable latent or early symtomatic stage
5) there should be a suitabel test/examination
6) test should acceptable to popoultion
7) natrual history of the comdition including development from latent to decleared disease

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16
Q

who is offered Colorectal cancer

screening

A

healthy individuals

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17
Q

what are the 2 tests

A

Faecal immunochemical test (FIT)

One-off sigmoidoscopy

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18
Q

what is FIT

A

detects haemoglobin in faeces, every 2 years for everyone aged 60-74

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19
Q

One-off sigmoidoscopy

A

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

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20
Q

test for Oesophageal cancer

A

endoscopy

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21
Q

to who

A

Regular endoscopy to patients with:
Barrett’s oesophagus
Low - high-grade dysplasia.

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22
Q

Pancreatic & Gastric cancer

test

A

No test exists that meets the W & J criteria.

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23
Q

how is it done

A

Depends on incidence - Japan screens for gastric cancer

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24
Q

who gets screened for Hepatocellular cancer

A

Regular ultrasound & AFP for high-risk individuals with cirrhosis (caused by Viral hepatitis
Alcoholic hepatitis.)

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25
Q

what other genreal category of people get screened

A

, specific screening programmes exist for individuals with genetic predisposition or strong family histories

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26
Q

what are the stages to a cancer patient

A

DIAGNOSIS
STAGING
TREATMENT

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27
Q

what is the diagnosis

A

What symptoms & signs does the patient present with?

How is the diagnosis made?

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28
Q

staging

A

investigations are needed to see how advanced the cancer is

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29
Q

TREATMENT

A

Can the cancer be surgically removed?

What systemic therapy (e.g. chemotherapy) or radiotherapy is available?

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30
Q

how are cancer patients treated by

A

by a cancer MDT

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31
Q

who is part of the MDT

A 
Radiologist
Palliative Care
Gastroenterologist
Oncologist
Surgeon
Cancer Nurse Specialist (CNS)
Pathologist
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32
Q

what does a patholigist do

A

Confirms the diagnosis of cancer using biopsy samples.

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33
Q

what is the function if histological sampling

A

Provides histologic typing, i.e. what type of cell does the cancer come from?

34
Q

what is molecular typing

A

i.e. what mutations does this cancer have?

Alongside the histological type, this can determine types of treatment available.

35
Q

what is tumour grade

A

how aggressive is the cancer?
Determined by how ‘abnormal’ cells & their nuclei are and how actively they are dividing.
how differentiated it is

36
Q

what do radioligist do

A

Reviews scans

37
Q

how are cancers reviewed

A

The TNM system used.

38
Q

what does the system stand for

A

T - size of Tumour.
N - lymph Node involvement
M - presence of distant Metastases.

39
Q

job of Oncologist

A

Decides on whether chemotherapy, radiotherapy or other systemic therapy is appropriate.
Coordinates the overall treatment plan

40
Q

what big desion does the MDT neeed to make

A

MDT decides whether plan should be for radical (curative) or palliative therapy or palliative care
Palliative care
CNS

41
Q

what is neoadjivant

A

chemo before surgery

42
Q

why neo

A

big tumour to shrink making surgery easier

high chance of cancer spread

43
Q

what is adjuvant chemo

A

after cancer has been taken away

44
Q

what is considered

A 
Takes into consideration
Type, grade & stage
Patient fitness (‘performance status’) and wishes.
45
Q

what is pallative therapy

A

tring to extend someones life when you know they are going to die from disease

46
Q

pallative care

A

letting someone die from disease and don’t treat as more harm then good e,g, cancer too far progressed

47
Q

what cancers occur on the upper 2/3 of the oesophagus

A

squmaous cell carcinoma

48
Q

what does it develop from

A

Develops from normal oesophageal squamous epithelium

49
Q

what effects the lower 1/3

A

Adenocarcinoma

50
Q

what sort of cancer is it

A

Squamous epithelium that has become columnar (metaplastic)

51
Q

what is it caused by

A

acid reflux

52
Q

what is the zigzag line

A

show sthe junction between
The Z line in the esophagus is the term for a faint zig-zag impression at the gastro-esophageal junction that demarcates the transition between the stratified squamous epithelium in the esophagus and the intestinal epithelium of the gastric cardia (the squamocolumnar junction).
stomach and oesophagus

53
Q

what is oesophagus inflammation called

A

osephagitis

54
Q

what is it due to

A

Gastro Oesophageal Reflux Disease GORD

55
Q

what can that become

A

Barrett’s oesophagus

intestinal metaplasia

56
Q

what is after Barrett’s oesophagus

intestinal metaplasia

A

Metaplasia → mild → moderate → severe dysplasia’ → cancer

57
Q

what is the last step

A

Adenocarcinoma (neoplasia)

58
Q

how do many oesophageal cancers present

A

Dysphagia (difficulty swallowing) commonest symptom

59
Q

how are they presented

A

Late presentation

60
Q

what does late presentation mean

A

65% at an advanced stage when diagnosed → palliative treatment.
as not suitable for potential curative treatment

61
Q

why are they diagnosed late

A

Significant cancer growth needs to occur before dysphagia develops (difficulty swallowing).
Often have metastases
Most patients deemed unfit for surgery at diagnosis (malnourished)
Importance of screening patients with reflux disease or Barrett’s oesophagus

62
Q

how do you assesss the diagnoses or stage of oesphageal cancer

A

Upper GI endoscopy (Oesohagogastroduodenoscopy, OGD)

63
Q

how is it done

A

camera in oesophagus
doen to stomach
then all the way to deuodenum

64
Q

what happens if you find something

A

bioposy

65
Q

how do you stage the cancer

A

CT of chest & abdomen
PET-CT scan to exclude metastases
Staging laparoscopy
To identify liver & peritoneal metastases
Endoscopic ultrasound
Via oesophagus to clarify depth of invasion & involvement of local lymph nodes

66
Q

how do you treat oesophageal cancer

A

first you need to knoe if you will cure or pallative(keeping them alive as long as possible)

67
Q

is you will cure what would you do

A

neoadjuavnt chemo and do surgery to remove

68
Q

and pallative

A

pallative chemo + steriods + and oesophageal stent

69
Q

what causes gastric cancer

A 
Gastric adenocarcinoma
Chronic gastritis is the major driver
Pernicious anaemia
H.pylori infection 
Partial gastrectomy (e.g. for an ulcer)
Epstein-Barr virus infection 
Family history  
High salt diet & smoking
70
Q

what’s the a cause of infection

A

H.pylori

71
Q

what is H pylori causing

A

due to chronic acid overproduction

more gastrin release
increase acid and pepsinogen

causing metaplasia of epithelium

72
Q

Pernicious anaemia

A

autoantibodies against parts & products of parietal cells

73
Q

what is Partial gastrectomy (e.g. for an ulcer)

A

removing a part of the stomach

74
Q

why dint we do it

A

as it is secondary to h pylori

treat with antibiotics and proton pump inhibor

75
Q

what is the problem in poeple with partial g

A

bile reflux

76
Q

how does the pathogenisis develop

A

Chronic gastritis → Intestinal metaplasia → Dysplasia → Malignancy

77
Q

Presentation of gastric cancer

A 
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
78
Q

what is the most common symptom

A

Dyspepsia (upper abdominal discomfort after eating or drinking) commonest symptom

79
Q

how do you diagnose

A
  • similar to oesophageal cancer: endoscopy + biopsy
80
Q

how do you stage

A

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

81
Q

how do you treat

A

neoadjuvant chemo

82
Q

why neo

A

as you can shrink the size of the tumour

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