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1B Gastroenterology > GI cancers > Flashcards

GI cancers Flashcards

1
Q

what is a cancer?

A

a disease 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 a primary cancer?

A

where cancer arises from

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3
Q

what is a secondary cancer?

A

metastasis- spread from another organ, directly or by other means (blood/lymph)

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4
Q

what are the hallmarks of cancer?

A

biological capabilities required by cancers

  1. sustaining proliferative signalling
  2. evading growth suppressors
  3. active invasion and metastasis
  4. enabling replicative immortality
  5. inducing angiogenesis
  6. resisting cell death
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5
Q

what are the emerging hallmarks of cancer?

A

deregulating cellular energetics

avoiding immune destruction

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6
Q

what are the enabling characteristics of cancer?

A

genome instability and mutation

tumour promoting inflammation

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7
Q

what are the highest cancer death types?

A

lung

bowel

prostate

breast

pancreas

oesophagus

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8
Q

where can neuroendocrine tumours occur?

A

all of GI tract from oesophagus to colon

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9
Q

what epithelial cancers of the GI tract can occur?

A

squamous- squamous cell carcinoma (SCC)

glandular epithelium-adenocarcinoma

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10
Q

what types of neuroendocrine cells can occur as cancers of GI tract?

A

enteroendocrine cells- neuroendocrine tumours (NETs)

interstitial cells of cajal- gastrointestinal stromal tumours (GISTs)

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11
Q

what are the connective tissues cancers of the GI tract?

A

smooth muscle- leiomyoma/leiomyosarcomas

adipose tissue- liposarcomas

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12
Q

what requirements are there for diseases to be suitable for screening?

A
  1. Condition sought should be an important health problem
  2. There should be an accepted treatment for patients with recognised disease
  3. Facilities for diagnosis and treatment should be available
  4. Recognisable latent or early symptomatic stage
  5. Suitable test or examination
  6. Test should be acceptable to the population
  7. Natural history of the condition, including development from latent to declared disease should be adequately understood
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13
Q

what are the screening tests for cancer?

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).
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14
Q

who is a regular endoscopy for oesophageal cancer offered to?

A
  • Barrett’s oesophagus
  • Low- or high-grade dysplasia.
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15
Q

are there screening tests for pancreatic and gastric cancer?

A
  • No test exists that meets the W & J criteria.
  • Depends on incidence - Japan screens for gastric cancer
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16
Q

what are the tests for hepatocellular cancer?

A
  • Regular ultrasound & AFP for high-risk individuals with cirrhosis
    • viral hepatitis
    • alcoholic hepatitis
    • NASH
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17
Q

what is the role of pathologist in cancer?

A
  • confirms diagnosis using biopsy samples
  • provides histological typing
    • what type of cell cancer comes from
    • epithelium (squamous cell carcinoma) or secretory cells (adenocarcinoma)
    • non-epithelial cells less common in GI tract
      • neuroendocrine tumours (e.g pancreas)
      • gastrointestinal stromal tumours (GISTS) (e.g stomach)
  • provides molecular typic
    • what mutations does cancer have
    • narrow down treatments available
  • provide tumour grade
    • how aggressive is cancer
    • determine how abnormal cells and nuclei are and how actively dividing
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18
Q

what is the role of the radiologist in cancer?

A
  • review scans
  • provide radiological tumour stage
    • TNM system
      • T- size of tumour
      • N- lymph node involvement
      • M- present of distant metastases
  • Provides restaging after treatment
  • Interventional radiology
    • Percutaneous samples
    • Radiological stents
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19
Q

what is the role of the surgeon in cancer?

A
  • Decide whether surgery is appropriate
    • Is tumour resectable
    • Is patient fit enough for surgery
  • Perform operation & care for patients in perioperative period
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20
Q

what is the role of the gastroenterologist in cancer?

A
  • Endoscopy- diagnostics & therapeutic
  • Upper GI (oesophagus and stomach)
    • Oesophageal & gastric biopsies
    • Oesophageal stents
  • Liver and pancreas
    • ERCP & EUS biopsies
    • Biliary stents
  • Lower GI
    • Colonic biopsies
    • Colonic stents
21
Q

what is the role of the oncologist in cancer?

A
  • Decides on whether chemotherapy, radiotherapy or other systemic therapy is appropriate.
  • This is determined by the scans, histological and molecular type.
  • Is the patient fit for full intensity therapy?
  • Coordinate overall treatment plan
22
Q

what are the different chemotherapy treatment plans

A

pre surgery (neoadjuvant)

after surgery (adjuvant)

e.g stomach haws better results in chemo first them surgery

adjuvant therapy do better than no adjuvant chemo

23
Q

what is a major driver of gastric adenocarcinoma?

A

chronic gastritis

24
Q

what are the causes of chronic gastritis?

A
  • 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
25
Q

what is the pathogenesis of gastric adenocarcinoma?

A

chronic gastritis -> intestinal metaplasia -> dysplasia -> malignancy

26
Q

what is the presentation of gastric adenocarcinoma?

A
  • Dyspepsia: upper abdominal discomfort after eating or drinking) commonest symptom
  • Red flags: ALARMS55
    • Anaemia
    • Loss weight or appetite
    • Abdominal mass on examination
    • Recent onset of progressive symptoms
    • Melaena or haematemesis
    • Swallowing difficulty
    • 55 years of age or older
27
Q

how is gastric adenocarcinoma diagnosed?

A

similar to oesophageal cancer: endoscopy and biopsy

28
Q

how is gastric adenocarcinoma staged?

A
  • CT of the chest, abdomen & pelvis will provide information on distant lesions
  • PET-CT (if looking to operate- metastases)
  • Diagnostic laparoscopy - peritoneal & liver metastases disease prior to full operation
  • Endoscopic ultrasound - will give most detail about local invasion & node involvement
29
Q

what is the treatment for gastric adenocarcinoma?

A
  • Palliative approaches: stenting or gastro-jejunal anastomosis
30
Q

what do neuroendocrine tumours (NETs) arise from?

A

gastroenteropancreatic (GEP) tract (or bronchopulmonary system)

arise from secretory cells of the neuroendocrine system

31
Q

what are neuroendocrine tumours (NETS) associated with?

A

sporadic tumours in 75%

genetic syndrome in 25%- multiple endocrine neoplasia type 1 (MEN1)

32
Q

where is MEN1 seen?

A

parathyroid tumours

pancreatic tumours

pituitary tumours

33
Q

what is the presentation of NETs?

A
  • Most asymptomatic & incidental findings
  • Secretion of hormones & their metabolites in 40%
    • serotonin, tachykinins (substance P) & other vasoactive peptides
  • < 10% of NETs produce symptoms
  • Can result in variety of debilitating effects
  • Carcinoid syndrome
34
Q

when is carcinoid syndrome usually seen

A

hepatic metastasis- cant break down serotonin

35
Q

what are the signs of carcinoid syndrome?

A
  • Vasodilation- flushing on face
  • Bronchoconstriction
  • Increased intestinal mobility
  • Endocardial fibrosis (PR & TR) (pulmonary and tricuspid regurgitation- carcinoid heart disease)
36
Q

what are the clinical features of pancreatic tumours?

A

insulinoma- hypoglycaemia, whipple’s triad

B cells

glucagonoma- diabetes mellitus, necrolytic migratory erythema

alpha cells

37
Q

what are the clincal features of pancreatic/duodenal tumours?

A

gastrinoma- zollingere-ellison syndrome

G cells

38
Q

what are the clinical features of entire GIT tumours?

A

VIPoma- Verner-morrison syndorome, watery diarrhoea

VIP cells

somatostatinoma- gallstones, diabetes mellitus, steatorrhoea

D cells

39
Q

what are the clinical features of midgut tumours?

A

most are non-functioning

40% develop carcinoid syndrome

40
Q

what are the clinical features of hindgut tumours?

A

ususally non-functioning

41
Q

what is the diagnosis for NETs?

A
  • investigations to localise the tumour & confirm the diagnosis with histology
  • Biochemical Assessment
  • Imaging
42
Q

what is the biochemical assessment for NETs?

A
  • 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)
43
Q

what are the options for imaging for NETs?

A
  • Cross-sectional imaging (CT and/or MRI)
  • Bowel imaging (endoscopy, barium follow through, capsule endoscopy)
  • Endoscopic ultrasound
  • Somatostatin receptor scintigraphy
    • 68Ga-DOTATATE PET/CT most sensitive
44
Q

what is the differences in grading of GEP-NETs?

A
  • High grade (poorly differentiated) neuroendocrine carcinoma à G3
  • Grade 3 lowest survival
  • Grade 1- live for years with very widespread disease
45
Q

what is the site of highest metastasis for GEP-NETs?

A

small intestine

pancreas second highest

46
Q

what is the treatment for NETs?

A
  • Curative resection (R0)
  • Cytoreductive resection (R1/R2)
  • Liver transplantation (OLTx)
  • RFA, microwave ablation
  • Embolisation (TAE), chemoembolisation (TACE)
  • Selective Internal RadioTherapy (SIRT)
  • Somatostatin receptor radionucleotide therapy
  • Medical therapy, targeted therapy, biotherapy
47
Q

what are the types of medical therapy, targeted therapy, biotherapy for NETs?

A

Octreotide, Lanreotide, SOM203

PK-inhibitors, mTOR-inhibitors

⍺-Interferon

48
Q
A

1B Gastroenterology (12 decks)

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